Delayed Metal Hypersensitivity from Surgical Clips Causing Progressive Neuropathy.

INTRODUCTION: Systemic immune reactions to surgical clips or implants remain underrecognized and pose a diagnostic challenge after minimally invasive surgeries. Although the incidence of metal hypersensitivity is increasing, these reactions are often overlooked because postoperative imaging and routine evaluations are frequently unremarkable. CASE PRESENTATION: A 65-year-old male developed progressive abdominal pain, bilateral lower extremity neuropathy, postprandial nausea, and autonomic dysfunction following laparoscopic cholecystectomy and inguinal hernia repair. Over several years, extensive imaging and evaluations failed to identify a structural cause. MELISA® testing revealed strong reactivity to multiple metals, with nickel most prominent. Diagnostic laparoscopy identified 16 retained metallic clips and an intestinal kink. Over six months of follow-up, removal of all clips led to stabilization of neuropathic and autonomic manifestations. Correction of the kink resulted in mild to moderate resolution of abdominal symptoms. DISCUSSION/CONCLUSION: This case highlights the importance of considering metal hypersensitivity in patients with unexplained postoperative symptoms. MELISA® may aid in evaluating implant-related metal hypersensitivity; however, because no single diagnostic test definitively excludes this condition, clinical judgment and temporal association remain important when evaluating carefully selected patients.