Spontaneous Migration of a Postcholecystectomy Surgical Clip From the Common Bile Duct to the Cecum Nineteen Years After Surgery: A Case Report.

Postcholecystectomy clip migration (PCCM) is a rare but recognized complication following cholecystectomy. The clinical presentation of PCCM often mimics that of choledocholithiasis, with symptoms including right upper quadrant pain and obstructive jaundice. Although the exact mechanisms underlying clip migration remain unclear, several theories have been proposed in the literature. While most cases occur shortly after the procedure, with clips migrating to the common bile duct (CBD) or, less commonly, to the duodenum; some instances may occasionally present much later, such as the case described here. An 85-year-old female presented with symptoms consistent with CBD obstruction, and the initial imaging revealed a clip in the CBD. Endoscopic retrograde cholangiopancreatography (ERCP) was planned; however, subsequent imaging showed that the clip had disappeared. Three days later, the clip was found in the cecum, and the patient's symptoms had improved. Given the patient's clinical progress, conservative management was pursued, allowing the clip to pass naturally without further intervention. While clip migration can lead to serious complications such as CBD obstruction or cholangitis, requiring procedural or surgical management, spontaneous resolution with conservative care, although rare, has been reported. The factors contributing to clip migration may include procedural factors early after surgery or chronic inflammatory changes and tissue necrosis that develop years after the cholecystectomy. Emerging techniques such as clipless surgery and the use of absorbable sutures are under development to reduce the risk of clip migration. In conclusion, despite its rarity, PCCM should be considered in patients with a history of cholecystectomy who present with symptoms suggestive of CBD obstruction. Although uncommon, clip migration may occur without significant complications and can resolve spontaneously, as demonstrated in this case. Conservative management may be an appropriate approach in select cases, particularly when the patient is clinically improving.