Benign expectoration of a surgical clip through a pneumonectomy stump

Migration of surgical clips through a right lobectomy stump mimicking an asthmatic syndrome

The mechanical stapler is routinely used in thoracic surgery practice to attend resection of bronchus and vessels. Herein, we reported a very rare complication as the migration of a titanium surgical clip through a right lobectomy stump. One year after the procedure, the patient complained of persistent cough. A misdiagnosis of asthma was made and she treated for 6 months with bronchodilators, corticosteroid and antihistaminic without success. Thus, patient re-referred of our unit. No clinical signs of infection as fewer, productive cough, dyspnea were present. The laboratory exams were within normal value including white cells. CT scan revealed no abnormalities. Bronchoscopy demonstrated a healed upper bronchus stump without evidence of an actual, open bronchopleural fistula but with clips apparently working their way into the airway, with approximately half of the clip visible within the lumen. The side of the clips that would be open before closure by the surgeon formed the leading edge of the clips visible in the lumen. The clips were successfully removed during flexible bronchoscopy with a forceps usually used for biopsy. After the procedure, the cough disappeared. The endoscopy check after 3 months showed a normal bronchial stump without evidence of fistula.

Laparoscopic treatment of a postoperative small bowel obstruction

We describe the case report of a 25-year-old female who presented with signs and symptoms of bowel obstruction status after laparoscopic treatment of an ectopic pregnancy performed 3 weeks earlier. The patient underwent laparoscopic lysis of adhesions and reduction of small bowel obstruction. This case report presents an atypical cause of postoperative bowel obstruction and reviews the current literature regarding laparoscopic surgery as an approach for treatment.