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

Jones, Michael; George, Bethan; Jameson, J. S.; Garcea, Giuseppe

doi:10.1136/bcr-2013-009124

Cited by 11 publications

(8 citation statements)

References 11 publications

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“…However, none of the abovementioned classifications cover all types of ERCP-related perforations. For instance, intestinal wall perforations caused by bile duct stent migration, as mentioned in this paper, and perforation of the jejunum, ileum, cecum, colon, and sigmoid colon due to bile duct stent migration, as mentioned in other studies [6][7][8][9][10], cannot be included in the above classifications.…”

Section: Discussionmentioning

confidence: 95%

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Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Wang

2020

BMC Gastroenterol

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Background: Endoscopic retrograde biliary drainage (ERBD) is the most frequently performed procedure for treating benign or malignant biliary obstruction. Although duodenal perforations secondary to the biliary plastic stent are quite rare, they can be life-threatening. The treatment strategies for such perforations are diverse and continue to be debated. Case presentation: We report three cases of duodenal perforation due to the migration of biliary plastic stents that were successfully managed using an endoscope. The three patients were admitted on complaints of abdominal pain after they underwent ERBD. Abdominal computerized tomography (CT) revealed migration of the biliary plastic stents and perforation of the duodenum. Endoscopy was immediately performed, and perforation was confirmed. All migrated stents were successfully extracted endoscopically by using snares. In two of the three cases, the duodenal defects were successfully closed with haemostatic clips after stent retrieval, and subsequently, endoscopic nasobiliary drainage tubes were inserted. After the endoscopy and medical treatment, all three patients recovered completely. Conclusions: Duodenal perforations due to the migration of biliary stents are rare, and the treatment strategies remain controversial. Our cases and cases in the literature demonstrate that abdominal CT is the preferred method of examination for such perforations, and endoscopic management is appropriate as a first-line treatment approach.

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Section: Discussionmentioning

confidence: 95%

“…However, gastrointestinal penetration or transmural perforation due to stent migration is rare, with an incidence of less than 1% [5]. Perforation due to biliary stent displacement can occur in the duodenum, jejunum, ileum, cecum, colon, and sigmoid colon [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Wang

2020

BMC Gastroenterol

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“…Early complications following ERCP has a 5% risk in the form of infection (35%), pancreatitis (29%),), bleeding (23%), perforation (6%), early stent migration (3%), and renal failure (3%). [3] Late complications in the form of stent migration (10%) either proximal or distal, stent obstruction, and infections are seen to occur due to failure in timely removal of the stents. [4] Proximal migration occurs in proximal hepatic ducts and present with jaundice.…”

Section: Discussionmentioning

confidence: 99%

An unusual case of biliary stent migration in sacrum

et al. 2019

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The common bile duct stenting has been a common endoscopic procedure practiced worldwide for the treatment of benign or malignant bile duct obstruction. Although the procedure has shown a very low morbidity, it is not free from complications. Stent migration has been a common late complication seen in 10% of cases presenting with various manifestations depending on the site of impaction. Here, we present a rare case of distal stent migration with impaction in the sacral foramina due to perforation through sigmoid diverticula with review of literature.

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“…D'Costa 1994 [8] M/73 N/A CBD cancer N/A N/A Sigmoid Surgery Baty 1996 [9] F/86 Diverticulosis Pancreas head cancer with CBD invasion N/A N/A Sigmoid Sigmoidectomy Schaafsma 1996 [10] F/77 Diverticulosis Acute cholangitis with CBD stone Straight 6 mo Sigmoid Surgery Lenzo 1998 [11] F/82 Diverticulosis Acute cholangitis with CBD stone Straight 10 Fr x 7.5 cm 4 wks Sigmoid Surgical primary closure Størkson 2000 [12] M/86 N/A Acute cholangitis with CBD stone Straight 7 Fr x 5 cm 2 yrs Sigmoid Surgical primary closure Figueiras 2001 [13] M/47 N/A Chronic pancreatitis with distal biliary stricture Straight 10 Fr x 10 cm 3 mo Splenic flexure Removal through colocutaneous fistula Klein 2001 [14] F/70 Diverticulosis CBD stone Straight 7 Fr x 5 cm 3 yrs Sigmoid Surgery Elliott 2003 [15] F/80 N/A Acute cholangitis with CBD stone Straight 10 Fr x 10 cm 4 mo Sigmoid Hartmann procedure Diller 2003 [16] F/58 Diverticulosis Post-LT bile duct stricture Straight 7 Fr x 10 cm 1 mo Sigmoid Sigmoidectomy Welhelm 2003 [3] F/85 Diverticulosis CBD stone Straight N/A Sigmoid Sigmoidectomy Anderson 2007 [17] F/80 Diverticulosis CBD stone Straight 5 mo Sigmoid Endoscopic removal Namdar 2007 [7] F/65 N/A Post-cholecystectomy bile leakage Straight 12 Fr x 10 cm 3 mo Rectum Rectal resection Bagul 2010 [18] F/79 Diverticulosis Post-cholecystectomy bile duct stricture Double pigtail 10 Fr x 9 cm 1 mo Sigmoid Endoscopic removal Jafferbhoy 2011 [19] F/82 Diverticulosis Post-cholecystectomy bile leakage Straight 7 Fr x 7 cm 3 mo Sigmoid Endoscopic removal and clip closure Lankisch 2011 [20] F/65 N/A Pancreas head cancer with CBD invasion Straight 10 Fr x 10 cm 2 wks Sigmoid Surgery Malgras 2011 [21] 73 y/o Diverticulosis Pancreas head cancer with CBD invasion Straight 10 Fr x 5 cm 15 d Sigmoid Hartmann procedure Wagemakers 2011 [22] F/76 Diverticulosis CBD stone N/A 1 mo Sigmoid Sigmoidectomy Alcaide 2012 [23] M/73 Diverticulosis CBD stone with benign biliary stricture Straight 10 Fr x 12 cm 15 d Sigmoid Endoscopic removal and clip closure Jones 2013 [24] M/66 N/A Post-op CBD stricture Straight 3 mo Cecum Endoscopic removal Mady 2015 [25] M *…”

Section: Location Of Perforation Treatmentmentioning

confidence: 99%

Colonic diverticular perforation by a migrated biliary stent

Park

Hong

et al. 2021

Medicine

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Rationale: Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature. Patients concerns: A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago. Diagnoses: Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis. Interventions: Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed. Outcomes: On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications. Lessons: Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.

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

Abstract: SUMMARYWe report a case of biliary stent migration causing perforation of the caecum and presenting as chronic abdominal pain. The case was managed by colonoscopic removal of the stent. BACKGROUND

Cited by 11 publications

References 11 publications

Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

An unusual case of biliary stent migration in sacrum

Colonic diverticular perforation by a migrated biliary stent

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