Post written by Mehul Choksi, MD, DM, from S. L. Raheja Hospital in Mumbai, India.

This video describes a patient who presented with primary bile duct stone formation 10 years after laparoscopic cholecystectomy. EUS showed presence of migrated surgical clips within the body of the bile duct stone. The migrated surgical clips actually act as a nidus for stone formation, which can lead to cholangitis, pancreatitis, and extrahepatic cholestatic jaundice. The EUS images distinctly show the clips within the stone and further confirmation of these lesser known adverse events was documented on cholangiogram and extraction of the bile duct stone at ERCP.

Although laparoscopic cholecystectomy is a very common surgery, surgical clip migration is still considered a rare event. Many therapeutic endoscopists are unaware of this adverse event and this video case is a classical teaching case. Furthermore diagnostic EUS can be considered as the primary modality to detect surgical clips or see for etiology of primary bile duct stone formation apart from abdominal x-ray, CT, or MRI.

EUS is a valuable investigation before therapeutic ERCP in the setting of dilated bile duct post laparoscopic cholecystectomy.

Read the full article here.