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Can Endo Clips Stuck In The Abdominal Cavity Cause Pain?

Posted on Thu, 27 Mar 2014

Question: Can endo clips stuck in the abdominal cavity cause pain? Appendectomy -2004 Cholesystectomy -2011 2 migrated clips in abdomen (1 x lower right pelvis) (1 x upper left abdomen) found on x ray Constant tearing Pain in RLQ for 1 year (no ovarian cysts, no masses or abnormalities found on MRI or ultrasound in pelvis) AND aching burning pain in LUQ for 3 days including Nerve pain from spleen area then down and around to front of abdomen and down to sharp nerve pain left groin that radiates down inner left thigh. (NOTE: FBC normal and all bloods normal, occasional tachycardia, blood pressure normal, no kidney stones, no kidney infection) Enlarged spleen for last 6 months - cause unknown usually good heart rate blood pressure always 120/80 ish

Answered by Dr. Vivek Chail (2 hours later)

Brief Answer: Please find detailed answer below. Detailed Answer: Hi, Thanks for writing in to us. I have read through your query in detail. Mirgrated laproscopy clips may get lodged within the tissues and fat in abdomen. This can mean that there is stimulation of nerve fibers which cn be felt as pain. Also there is the possibility of foreign body granuloma formation which is accumulation of white blood cells around the clips which are perceived as foreign bodies by the body. Please discuss the above possibilities with your doctor. Hope your query is answered. Do write back if you have any doubts. Regards, Dr.Vivek

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (15 hours later)

Thankyou. I have a few more questions. 1.) In your opinion, if two migrated endo clips in the abdominal cavity were found at the exact locations of a chronic pain (RLQ) and an acute pain (LUQ), where the pain had no other explanation, would you consider they're removal as an option? 2.) Is it possible for foreign body granulomas to contribute to splenomegaly?

Answered by Dr. Vivek Chail (17 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing back with an update. The spleen is an organ located in left upper abdomen. It is enlarged due to many reasons and when that happens it starts growing from LUQ to RLQ. Now I would like to know if your spleen is enlarged such that it is causing pain in LUQ and RLQ. If that is not the case with you then the exact location of the clips and if they are causing any effects on the walls of bowel or organs is most important to be known. I would first observe complete details and try to evaluate the physical location of the clips after discussing with the surgeon and then recommend removal only if sure enough that it cannot control with usual pain killer medications. Tramadol is a higher pain killer. There are situations where subsequent surgery can give rise to more pain than earlier. Splenomegaly can be caused due to many reasons which can include a low grade chronic inflammation. Normally spleen more than 13 cms is termed enlarged. Severely enlarged spleen (large enough to reach RLQ) cannot be caused by granuloma. Hope I have been able to answer your query. Further queries are welcome.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Vivek Chail (5 hours later)

The spleen is palpable by 5cm below rib cage. It has caused chronic discomfort is in the LUQ. This has been the case for several months. They have not found a cause for it. There have been no mono, malaria, infection or blood disorders found. There is a new acute stabbing pain in the LUQ, nerve pain down to groin and an occasional pulsing feeling as though I can feel my heart beat there. In an x ray, taken after presenting with the pain, it was noted that a clip was there. Do u think that the clip could be causing the new acute pain? Do u think that the presence of the clips in the abdomen could be causing foreign body granuloma, which could in turn be contributing to an enlarged spleen (palpable 5cm below ribs) ? Thanks

Answered by Dr. Vivek Chail (15 hours later)

Brief Answer: Please find detailed answer below Detailed Answer: Hi, Thanks for writing back with an update. The new acute pain going down to the groin on the left side needs to be evaluated keeping the urinary system (especially the left kidney and ureter) in mind. X ray finding of a clip needs to be confirmed with a CT scan which will show the exact location and plane. There is no way the clip can enter the kidney therefore the closest similar condition (causing pain from LUQ to groin) can be a stone in the kidney or ureter. I need to have a look at X ray before confirming clip (position and size) in LUQ and correlating it to your pain. Until then I cannot exclude the fact that the clip isn't causing your new pain. There have been cases I know where even after a laproscopic uterine surgery the patient developed foreign body granuloma causing severe lower abdominal pain. The granuloma developed as an immune reaction to the suture material. The 5 cm splenic enlargement below ribs is a relative finding. The absolute spleen measurement (through ultrasound scan) can give more information. The spleen is a concentration of white blood cells and may be enlarged mildly due to any foreign body reaction. It may be important to know that some people may also have mild spleen enlargement for no particular reason. The common causes of splenomegaly include the following: Vascular congestion Cirrhosis Splenic vein thrombosis Portal vein thrombosis Reticuloendothelial hyperplasia Acute infections (e.g., typhoid fever, cytomegalovirus, Epstein-Barr virus infection) Subacute or chronic infections (e.g., bacterial endocarditis, brucellosis, tuberculosis, histoplasmosis, malaria) Collagen-vascular diseases and abnormal immune responses (e.g., systemic lupus erythematosus, serum sickness, sarcoidosis) Work hypertrophy Hemolytic anemias (e.g., spherocytosis) Infiltrative or replacement processes Nonmalignant hematologic disorders (e.g., polycythemia vera, myelofibrosis) Leukemias Lymphomas Metastatic solid tumors Storage diseases (e.g., Gaucher's disease) Amyloidosis Benign tumor and cysts Abscess Subcapsular hemorrhage The above list is exhaustive and for information purposes only. Please do not get worried about any serious disorder because if you were to have any, it would have been diagnosed by now. Hope your query is answered at least partially. Do write back if you have any doubts. Regards, Dr.Vivek

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar