EP 385 Hem-O-Lok Clips Migration Through the Appendiceal Orifice into the Caecal Lumen Following Laparoscopic Appendicectomy: An Incidental Finding on Diagnostic Colonoscopy

Abstract

Hem-o-Lok clips are commonly used for appendiceal stump closure during laparoscopic appendicectomy due to their safety, ease of use and cost-effectiveness. Clip migration is a recognised but extremely rare complication, and reports following appendicectomy are exceptionally uncommon.

We describe a woman in her 70s who underwent emergency laparoscopic appendicectomy for acute appendicitis, with Hem-o-Lok clips applied at the appendiceal base. Recovery was uncomplicated. Three months later, a diagnostic colonoscopy was performed to assess an unrelated incidental CT finding and due to a strong family history of colorectal cancer. Colonoscopy revealed a large sessile serrated lesion and unexpected Hem-o-Lok clips protruding intraluminally from the appendiceal orifice into the caecum. The patient remained asymptomatic, and no intervention was undertaken for the Hem-o-Lok clips.

To our knowledge, this represents the first reported case of intraluminal Hem-o-Lok migration into the caecum following laparoscopic appendicectomy. Awareness of this rare finding is important to avoid misinterpretation and guide safe endoscopic management.