Year 2023 / Volume 115 / Number 6
Digestive Diseases Image
A case of a rare foreign object found in the stomach — A Hem-o-Lok clip after laparoscopic distal pancreatectomy

320-321

DOI: 10.17235/reed.2022.8912/2022

Koichi Soga,

Abstract
We assessed an 81-year-old woman who underwent laparoscopic distal pancreatectomy for a large branched-type intraductal papillary mucinous neoplasm. An enlarged and infected 60-mm cyst was found adjacent to the resection margin one month after surgery. The non-absorbable polymer clip (NAPC: Hem-o-Lok), which was used for ligation of the splenic artery, could also be visualized. We performed endoscopic ultrasound guided-cyst drainage (EUS-CD) for controlling the enlarged and infected cyst. Further, we planned to remove the tube endoscopically after 6 months. During esophagogastroduodenoscopy six months later, the post-EUS-CD scar could be detected without the EUS-CD tube. However, a white artifact could be seen protruding from the outside of the gastric wall into the stomach. Despite the difference in color and morphology, we thought the EUS-CD tube might have been torn at first. We grasped the artifact with endoscopic forceps, and the object was identified as an NAPC. We considered that the fragility and inflammation of the pancreas and surrounding tissues led to the collection of necrotic pancreatic fluid, resulting in an inflammatory response. Upon tearing the puncture hole little by little following EUS-CD, the NAPC was dislodged as an unanticipated foreign body.
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References
1.Soga K, Kassai K, Itani K. Duodenal ulcer induced by Hem-o-Lok clip after reduced port laparoscopic cholecystectomy. J Gastrointestin Liver Dis 2016; 25: 95-8.
2.Zhang Q, Deng D, Chen C, et al. Endoscopic submucosal dissection treatment of a case of Hem-o-lok clip migration into the rectum submucosa. Rev Esp Enferm Dig 2022 May 12: doi: 10.17235/reed.2022.8897/2022. Online ahead of print.
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Soga K. A case of a rare foreign object found in the stomach — A Hem-o-Lok clip after laparoscopic distal pancreatectomy. 8912/2022


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Publication history

Received: 07/05/2022

Accepted: 15/05/2022

Online First: 31/05/2022

Published: 06/06/2023

Article Online First time: 24 days

Article editing time: 395 days


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