Delayed Metal Hypersensitivity from Surgical Clips Causing Progressive Neuropathy.
Satyamedha Bathula, Oluwasegun J Olowe, Amanda Lalama et al.
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Case in brief
A 65-year-old male presented with progressive abdominal pain, bilateral lower extremity neuropathy, postprandial nausea, and autonomic dysfunction after laparoscopic cholecystectomy and inguinal hernia repair. Extensive evaluations were unremarkable until MELISA® testing indicated strong reactivity to metals, particularly nickel. Diagnostic laparoscopy revealed 16 retained metallic clips and an intestinal kink. Removal of the clips stabilized neuropathic symptoms, while correction of the kink improved abdominal issues.
Diagnostic / clinical pearl
Clinicians should consider metal hypersensitivity in patients with unexplained postoperative symptoms, as standard imaging may not reveal the underlying cause.
Why it matters
This case underscores the need for awareness of metal hypersensitivity as a potential diagnosis in postoperative patients, highlighting the role of specialized testing like MELISA®.