Iatrogenic duodenal perforations caused by endoscopic biliary stenting and stent migration: an update

Abstract

Endoscopic biliary stenting is the preferred method of decompression in obstructive jaundice. Duodenal perforations caused during stenting and stent migration are rare but life-threatening complications, and require judicious management. With the increasing use of therapeutic endoscopy, an awareness of these complications is becoming important in our surgical practice. Advances in interventional radiology, endoscopy, and laparoscopy have enhanced the scope and reduced the morbidity of both conservative and surgical treatments of these perforations. This article presents an update on the current state of our knowledge on the science and the management of this complication.

Endoscopic duodenal perforation: surgical strategies in a regional centre

“…Without surgical intervention death is likely from a combination of massive auto-digestion, nutritional depletion and sepsis. Delay in diagnosis increases the likelihood of a fatal outcome [16,17]. …”

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

“…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.…”

Colonic perforation with duodenal-colic fistula formation by a biliary stent in a liver transplant recipient

“…Duodenal perforation by a biliary stent has been reported previously [3,4]. No prior reports of a duodenal-colonic fistula by a biliary stent have been reported.…”

“…As such Endoscopic retrograde cholangiopancreatography (ERCP) has also been increasing utilized in this group of patients for both diagnostic and therapeutic purposes. While undoubtedly an excellent technology, ERCP carries particular risks, in the setting of biliary stenting, these include complications of pancreatitis (~5%), cholangitis (<5%) and perforation (<1%) [1][2][3]. Herein, is reported a novel case of biliary stent perforation with duodenal-colic fistula formation in an orthotopic liver transplant (OLT) patient.…”