ABSTRACT A 75‐year‐old man presented with epigastric pain 10 years after undergoing a laparoscopic cholecystectomy for acute calculous cholecystitis. Prior to surgery, severe inflammation necessitated ligation and clipping of the gallbladder neck. On admission, laboratory tests revealed elevated cholestatic liver enzyme levels and hyperbilirubinemia. Computed tomography (CT) revealed intrahepatic bile duct dilatation, multiple common bile duct (CBD) stones, and a metallic artifact in the distal CBD. Endoscopic retrograde cholangiopancreatography revealed multiple CBD stones and a linear radiopaque shadow. Abdominal radiography revealed the disappearance of two cholecystectomy clips, indicating that the surgical clips had migrated from the peritoneal cavity into the CBD. Endoscopic sphincterotomy was performed, followed by staged stone extraction. A basket catheter was used to retrieve a fractured cholesterol stone, revealing a surgical clip — confirmed to be the nidus — at its core. The remaining stones were fragmented and removed endoscopically, with an uneventful recovery. In contrast, the other missing clip was not identified on subsequent CT or plain radiography, suggesting possible spontaneous passage. This case illustrates that migrated surgical clips can act as a nidus for CBD stone formation, presenting as late‐onset cholangitis even a decade after cholecystectomy.
Nomiya et al. (2026) studied this question.