An unusual cause of ileal perforation: Report of a case and literature review

Abstract

An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease. We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.

A review of problems following insertion of biliary stents illustrated by an unusual complication

“…17,21 Multiple stents are associated with a decreased frequency of migration possibly due to the fact that they will be held more tightly within the stricture and there may be increased friction between the stents (particularly when they have been placed for any length of time and the surface becomes irregular). 21,32 Migration of biliary stents can lead to impaction in the distal bowel and the commonest cause is an extrinsic fixation or irregularity of the bowel wall such as the ligament of Trietz, 7 parastomal hernias, abdominal hernias, adhesions, colonic diverticulae 4 and, rarely, in the orifice of the appendix. 8 The complications that result following stent migration and impaction have been broadly classified into penetration, perforation, intraabdominal sepsis and obstruction of the intestine, 41 50 Rarely, other cavities or organs such as pleura or pancreas can be effected 14,15 and, as reported by ourselves, very rarely groin abscess.…”

Small Bowel Perforation Due to Fish Bone: A Case Report

“…8 There are reported cases of GIS perforation as a result of biliary stent migration in the literature. 9 According to the study of Madrona et al, the most common cause of intestinal perforation associated with foreign bodies are chicken bones. 2 Chu et al report that swallowed fishbones are the most common cause of intestinal perforation associated with foreign bodies in Hong Kong.…”

Biliary stent migration causing perforation of the caecum and chronic abdominal pain

“…The majority of distally migrated plastic stents pass unnoticed through the digestive tract2 but a proportion of these migrated stents can lodge in the bowel leading to local complications, with straight plastic stents posing the greatest risk 3 4. The most commonly reported complication is that of perforation, occurring in less than 1% of cases,5 but cases of fistula formation,6 obstruction,7 abscess formation and appendicitis8 have also been reported.…”

“…The most commonly reported complication is that of perforation, occurring in less than 1% of cases,5 but cases of fistula formation,6 obstruction,7 abscess formation and appendicitis8 have also been reported. Ninety-two per cent of perforations occur in the duodenum,3 but an increasing number of cases of migrated stents causing late complications in the distal small bowel and colon are being reported 9. Most cases of distal bowel perforation with biliary stents tend to occur in pre-existing pathologies of the bowel, such as within incisional hernia or diverticulum 2.…”