A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent

Abstract

SummaryBackgroundStent insertion is widely performed to restore biliary drainage in hepatic, biliary, and pancreatic obstructive conditions. Intestinal perforation due to the migration of these stents is an extremely rare late-term complication that is associated with a high rate of mortality. The current report aimed at presenting the radiological findings of a case of extraluminal biliary stent migration into the pelvic region that caused intestinal perforation.Case ReportWe report a case of an 85-year-old male with a history of previous stent insertion who presented with a sudden – onset severe abdominal pain. An abdominal multidetector computed tomography (MDCT) revealed a tubular foreign body density, compatible with intestinal perforation due to migration of the biliary stent.ConclusionsBiliary stent insertion becomes a more common procedure. This serious complication must always be remembered in patients presenting with abdominal pain after stent insertion.

Rare Complication of Sigmoid Colon Perforation by Migrated Plastic Biliary Stent: Two Case Reports and Literature Review

“…Complications including stent occlusion by clogging with possible subsequent cholecystitis or cholangitis, pancreatitis from biliary manipulation, hemorrhage, stent rupture, and stent migration have been described comprehensively [4,[6][7][8][9]. Biliary stent complications have an incidence rate of 5% to 10% [6][7][8][9] and can be further categorized into proximal and distal migration. The distally migrated stents could pass through the bowel without complications.…”

Small bowel perforation from a migrated biliary stent: A case report and review of literature

“…It was first described in 1980 by Soehandra et al [ 5 ] as an alternative method of decompressing the biliary system for high risk or inoperable cases instead of surgical choledochoduodenostomy. After the first description of endoscopic biliary stent placement, the whole procedure and the available stents have been significantly improved and the popularity of this technique is gradually increasing as it constitutes a less morbid intervention comparing to a surgical operation[ 6 ]. Despite its clear benefit and the significant improvements in this field, there is always the risk of significant complications during or after endoscopic procedures like upper endoscopy and biliary tract cannulation.…”

“…Well described complications of biliary stent placement include stent occlusion by clogging with possible subsequent cholecystitis or cholangitis, pancreatitis from duct manipulation, hemorrhage, stent fracture and stent migration[ 1 , 2 , 6 , 7 ]. The total rate of biliary stent complications varies among different institutes because of different level of experience, different available equipment and different etiologic reasons for the intervention.…”

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“…Thus, after a 5-month follow-up with abdominal x-rays, where no significant changes were observed in the location of the prosthesis, it was decided to perform an abdominal CT scan, both to locate the stent and to provide the endoscopist with detailed information of the abnormal post-surgical anatomy of the patient's upper gastrointestinal tract. 23 Lastly, the prosthesis was localized in the duodenum with its distal end in the area of jejunojejunal anastomosis (Figure 8). We understand that at the beginning of the surgical Roux-en-Y hepaticojejunostomy there was a migration of the prosthesis, which remained in the duodenum until the end of the procedure.…”