Ann Surg Treat Res.  2018 Mar;94(3):159-161. 10.4174/astr.2018.94.3.159.

Silent invasion of Hem-O-Lok clip

• Park DJ
• Kim BG
• Jeong ID
• Kim GY

• KMID: 2405329
• DOI: http://doi.org/10.4174/astr.2018.94.3.159

Abstract

A 58-year-old man underwent laparoscopy-assisted distal gastrectomy (LADG) with Billroth I gastroduodenostomy due to early gastric cancer. During surgery, the perigastric vessels were ligated with Hem-o-Lok clips. Esophagogastroduodenoscopy (EGD) 6 months later showed a fungating mass at the anastomosis site. Repeat EGD 1 year after LADG showed a Hem-o-Lok clip at the fungating mass lesion. Because the patient was asymptomatic, with no major abnormalities on clinical examination, and endoscopic removal of the clip would have been difficult due to the presence of adhesions and inflammation, no attempt was made to remove the clip. The patient remained well after the exposed Hem-o-Lok clip was identified. A third EGD 6 months later showed that the clip had disappeared from the anastomosis site, and that this site was covered with normal mucosa surrounding the scar.

Keyword

Surgical instruments; Postoperative complications; Foreign-body migration; Gastrectomy; Stomach neoplasms

MeSH Terms

Cicatrix
Endoscopy, Digestive System
Foreign-Body Migration
Gastrectomy
Gastroenterostomy
Humans
Inflammation
Middle Aged
Mucous Membrane
Postoperative Complications
Stomach Neoplasms
Surgical Instruments

Figure

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  Fig. 1 Photographs showing an applier (A) and its Hem-o-Lok clip (B).

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  Fig. 2 Photographs showing a applied Hem-o-Lok clip (arrow) at right gastroepiploic artery.

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  Fig. 3 (A) Endoscopic view during routine follow-up esophagogastroduodenoscopy (EGD) 6 months after laparoscopy-assisted distal gastrectomy (LADG), showing a fungating mass at the anastomosis site. (B) Endoscopic view during routine follow-up EGD 1 year after LADG, showing the presence of a Hem-o-Lok clip at the site of the fungating mass lesion. (C) Endoscopic view during routine follow-up EGD 18 months after LADG, showing that the clip had disappeared from the anastomosis site.

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