A case of a rare foreign object found in the stomach - A Hem-o-Lok clip after laparoscopic distal pancreatectomy

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.