To the Editor.—Although recurrent choledocholithiasis usually results from calculi not recognized, or calculi recognized but not removed during prior biliary tract surgery, common bile duct stones may also form around various kinds of ligature material used during earlier biliary operations.
Report of a Case.—Approximately one year after a common bile duct exploration, a 72-year-old man returned with a right-upper-quadrant pain similar to his previous distress. An endoscopic retrograde cholangiopancreatogram revealed a recurrent common bile duct stone that had formed around a hemostatic clip used during the first operation.1 Presumably, the clip became dislodged when the T tube was removed and then migrated down the tract, into the duct, to act as a nidus for stone formation. Since endoscopic removal was not available, the patient underwent uncomplicated surgical removal of the stone.
Endoscopic retrograde cholangiography demonstrating 1.5-cm gallstone in the gallbladder (A). Contrast material is leaking from perforation
MARGOLIS JL. Recurrent Choledocholithiasis due to Hemostatic Clip. Arch Surg. 1986;121(10):1213. doi:10.1001/archsurg.1986.01400100125026