A Case of CholangioDuodenal Fistula Formation After Metallic Stenting for Malignant Biliary Stricture

Abstract

A 68‐year‐old man presented with melena in June 1993, and was diagnosed as having adenocarcinoma of the rectum with liver metastasis. He underwent anterior resection of the rectum and was given weekly chemotherapy. In October 1993, he developed jaundice due to severe stricture of the middle to lower common bile duct caused by metastatic spread to the lymph nodes around the pancreatic head. A 10mm wide, 51mm long WallstentTM (Schneider) was inserted into the lower end of the bile duct through the papilla, resulting in rapid normalization of the serum bilirubin level. Three months later, the Wallstent eroded through the duodenal wall, causing massive fatal hemorrhage. We, therefore, emphasize the necessity of being alert to the potential for such complications in cases involving placement of a self‐expanding metallic stent for malignant biliary stricture.

Choledochoduodenal Fistula after the Placement of a Partially Covered Metal Stent for Unresectable Pancreatic Cancer

“…The primary causes of CDF are choledocholithiasis and a penetrating peptic ulcer (2,3). CDF is also a relatively rare, delayed complication of metal stent placement, which has been reported to be caused by bile duct wall injury due to stent migration or the sharp end of the metal stent with a poor prognosis (4)(5)(6)(7)(8)(9). We herein present a rare case of CDF after the placement of a partially covered metal stent for distal common bile duct obstruction in a patient with unresectable pancreatic cancer.…”

Late Migration of Covered Metal Stent to the Stomach Through a Spontaneous Choledochoduodenal Fistula in a Patient With Malignant Biliary Obstruction

“…To our knowledge, the cases of only 3 patients with choledochoduodenal fistula due to SEMS have been reported thus far [ 8 - 10 ]. Ryozawa et al reported the case of a patient with obstructive jaundice due to lymph node metastasis of rectal cancer; a choledochoduodenal fistula without stent migration was found 3 months after inserting uncovered SEMS because of tarry stool [ 8 ].In addition, Lee et al reported a patient with ampulla of Vater carcinoma; a choledochoduodenal fistula without stent migration was diagnosed 40 days after placement of an uncovered metallic biliary stent because of a severe pain in the right upper quadrant of the abdomen with jaundice [ 10 ]. Krokidis et al reported a patient with cancer of the pancreatic uncinate process accompanied with late migration of a covered SEMS through a spontaneous choledochoduodenal fistula 13 months after stent insertion because of fatigue, weakness, and abdominal pain, and stent migration was not detected in the entire body [ 9 ].…”

“…The rate of stent migration, in particular, is 1.8% to 8.3% [ 3 - 7 ]. Spontaneous choledochoduodenal fistulas are rarely associated with the placement of SEMS [ 8 - 10 ]. To our knowledge, this is the first report on late migration of a covered SEMS to the stomach through a spontaneous choledochoduodenal fistula in a patient with malignant biliary obstruction.…”

Endoscopic biliary stenting: Plastic stent or expandable metallic stent?

“…Results with Gianturco and Strecker stents are particularly disappointing, in the former because of a higher risk of tumor ingrowth due to the wider mesh design and the wide delivery system, and in the latter because of the high frequency of balloon‐related deployment difficulties 43. Reports of major injury to adjacent organs are increasing with the growing number of metal stents used 44,45…”