Abstract:Background and Aims Hem-o-lok clips are widely used for cystic duct and vascular closure during laparoscopic cholecystectomy (LC). Although rare, postoperative clip migration may occur, with the clip entering the common bile duct (CBD) and acting as a foreign body. Its imaging features often mimic choledocholithiasis, posing diagnostic and therapeutic challenges. Clinical awareness of this late complication remains insufficient. This study aims to summarize the clinical characteristics and management strategies through a case analysis and literature review.Methods The clinical data of a 29-year-old woman admitted in October 2025, four years after LC, were retrospectively reviewed. She was diagnosed with suspected CBD stones during routine examination one year prior to admission. Preoperative imaging revealed multiple filling defects in the CBD. The patient declined endoscopic retrograde cholangiopancreatography and underwent laparoscopic common bile duct exploration (LCBDE). Intraoperative findings, imaging characteristics, diagnostic process, and management were analyzed in conjunction with relevant literature.Results Preoperative imaging suggested multiple CBD stones. During LCBDE, three migrated Hem-o-lok clips were identified and removed from the middle and lower CBD under choledochoscopic guidance. No pigment stones were observed around the clips. The final diagnosis was foreign bodies in the CBD (Hem-o-lok clips). A T-tube was placed for drainage. The patient recovered uneventfully and was discharged. Two months later, T-tube cholangiography confirmed a patent CBD without residual stones or foreign bodies, and the tube was removed successfully.Conclusion Hem-o-lok clip migration is a rare long-term complication after LC and is easily misdiagnosed as choledocholithiasis. In patients with a history of LC, clip migration should be considered in the differential diagnosis. LCBDE is an effective diagnostic and therapeutic approach. Standardized surgical techniques, appropriate selection of closure devices, and long-term follow-up are essential to minimize this complication.