Surgical clip penetrating abdominal aorta

[danni3808]

I had sugery in Oct 06 for colon cancer.  During surgery, I had multiple organ failure (heart, lungs, liver, kidney) and also had septic shock septicemia, septic shock, anastomosis leak, coma, 40 pound fluid overload and more.  I know, I'm lucky to be alive, or that's what I hear.  I have experienced continuous extreme pain in my back, and my abdomen always feels like I have a porcipine moving around.  Any type of Abdominal movement (attempted sit ups or stretching) feels like my guts are tearing, then I have extreme pain for 6 weeks or more (that is more pain than normal).  I was otherwise healthy before, or I felt OK and worked out everyday.  I don't have pain in my upper right quadrant of my abdomin (abdomen) (no symptoms of gallbladder disease).  I have been diagnosed since surgery with PAD, disease of the aorta arch, gallbladder is swollen and has possible cholecysitis, nerve damage, free fluid of unknown origin and so on.  I have a surgical clip that appears to be pressing into my aorta in my abdomen, the report  says "the surgical clip appears to be adjacent to the aorta".  Several other scans confirm the presence of this clip,it's about 2 1/2".  I also have several surgical clips in my presacral location. I have the CT scan W/O contrast that shows the location of the clip.  None of these clips are in the location of the anastomosis, where small caladum staples are present.  There is no mention of aorta involvement in the surgery.  

Now, at last my question.  My pain is increasing, especially in my gut and back.  Could the clips be causing the unbearable pain in my gut and back?  And how dangerous would it be to have them removed?  How dangerous is it to leave it in there?  I'm working, but not without pain meds and shots in my back and I experience extreme fatique from the pain.  My goal is to live without pain (and pain meds).  I'm willing to take some risks if this could be accomplished.  Could the clips be causing the pain?

[Lee Kirksey, MD]

When surgical clips are used to control bleeding they remain in place because if they were removed, the bleeding would recur. Another recommendation would be that you gather all of your record and xrays and find your nearest regional experts in abdominal surgery or vascular surgery and go somewhere else to be evaluated. Perhaps you need a new set of eyes to evaluate your problem. If you tell me where you reside, I might be able to suggest a place. I have trained for many years and practiced for a decade and I have never seen a clip the size of the one your describe. I would be interested to read the operative dictation of your procedure and to see the x rays

[Lee Kirksey, MD]

It sounds like you have been through quite a bit. The story that describe is quite complex and without having images and records to review, it would be difficult to fathom a guess. I would consult the operating surgeon to see if he/she can give you some insight about the location of the non anastomotic clips in the abdomen. It is not uncommon to use surgical clips to control blood vessels during the operation.  It would seem unlikely that the location of these clips would be contributing to your pain. For the most part, the only pain that is associated with a blood vessel like the aorta occurs when the vessel is increasing in size rapidly in cases like abdominal aortic aneurysms. The removal of the clips would probably be very challenging if not impossible because after an operation like yours, there is a dense amount of scar tissue which would almost make it similar to looking for a needle in a haystack to find those relatively small clips. My question is what have the told you about the origin of your pain. Have you been evaluated by a neurologist? A vascular doctor for your PAD.  I would be concerned about abdominal wall hernia and incisional changes with the type of pain that you describe

I would suggest that you schedule an appointment to speak to the person most familiar with your condition, the operation and your post operative course--the operating surgeon. Im sure they would be happy to clarify things as much as possible. Good luck

[danni3808]

They do not know the origin of the pain, and I was referred to a pain management clinic for pain meds.  The clip is 2 1/2 inches is size (very large on an xray).  I have been to a neurologist but he could not specifically identify the source of the pain.  I have not seen a vascular doctor for the PAD or the aerotic arch, but will find one on Monday.  My legs also hurt.  When surgical clips are used to control bleeding, are they normally left in the body?

[mirade]

I have in excess of thirty metal surgical clips in my abdomen, the lower lumbar regions and two on the retroperitoneum. I had no interest in sex for three years  post hysterectomyand then i attempted intercourse and experienced a give way sensation in my lower left abdomen and i developed a grossly swollen left leg in the following 24-36 hours. Hospitalised,not scanned,diagnosed DVT?  I now have radiological confirmation  (pelvic CT with contrast) that two clips have given way and migrated medially in the lower left and have finished up adjacent the left external iliac vein. The radiologist also confirms a significant constriction of the left external iliac vein. I have now been hospitalised 15 times with this grossly swollen and regularly infected left leg which has been described as lymphoedema-lymphangitis,thrombophlebitis and recurrent cellulitis. My medications are permanent antibiotics (Penicillin) permanent painkillers for the permanent pain and discomfort in my lower left abdomen and the two painful spots either side of my lower back. Thankfully i have not been hospitalised again since the introduction of the permanent antibiotics following the 15th hospitalisation. My leg has stayed grossly swollen from the time of the give way and i would like to hear your opinion regarding the possible removal of the offending clips and the placement of a stent at the site of the venous obstruction. My physician has refused to sanction the removal of the offending clips but i believe that he is hamstrung by the opinions of the hospital that placed this large amount of clips in my abdomen "Without my knowledge" and who then proceeded to wrongly diagnose me and wrongly treat me for my REAL condition for many years. I now have to look elsewhere for help and hopefully you can point me in the right direction. Mirade.

[danni3808]

FYI - I paid a $20 one time charge for the answer I received.  I'm sorry to hear about your issues, the vein issue sounds like mine as well.  There is a doctor in Kernersville NC that will admit that metal in your body will cause infection and prevent recovery.  She says infections get under the metal.  Her name is Dr Elizabeth Vaugh.  She has a web site if you do a search.  She's not on my "provider list" from my insurance company and I think you have to pay upfront.  I don't know if she knows any surgeons that will deal with this type of issue, but if you can find one, please let me know.  I think I'm there along with you, between a rock and a hard space.

[mirade]

I recently approached a consultant vascular surgeon with a view to having offending metal clips removed and contrary to your views he said YES they can be removed, no problem (his words) . I was absolutely delighted to hear this good news having suffered terrible problems related to these clips for many years. However when he consulted the hospital that had placed all these clips in my abdomen "Without my knowledge" he then had a change of heart stating that in my particular case the risks outweighed any potential benefits??? It stinks. I firmly believe that he was talked out out of it. I am not giving up and i will find a surgeon somewhere who will do the honourable thing and give me some quality time in my remaining years.

[mirade]

A related discussion, The removal of offending metal surgical clips was started.