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Conservative surgical treatment for jejuno-ileal angiodysplasia.

the CBD. A recent review by Chong et al showed that most of the patients with clip migration present at an elderly age with the average time interval from cholecystectomy to clinical presentation being two years. Common presentations are obstructive jaundice, cholangitis, biliary colic and acute pancreatitis. While our first patient had only cholangitis, the second patient had recurrent biliary colic and biliary pancreatitis. Since the clips get embedded inside the stones, they are often missed during evaluation. The clips can be seen on a plain X-ray abdomen, CT abdomen or MRCP. On a plain X-ray it is difficult to ascertain the exact position of the clip in relation to the stone and the bile duct. Ultrasound abdomen is not a good modality as it is difficult to identify the clips. Although CT and MRCP can detect clips and their relation to the stone and bile duct, ERCP is the preferred investigation because it can simultaneously aid in removal of these calculi. The success rate of managing these calculi using ERCP is almost 80%. The remaining patients usually require surgical intervention. One of our patients had successful removal of the stone by ERCP while the other was successfully managed by laparotomy after a failed ERCP.