Migratory biliary stent resulting in colonic perforation: a rare complication and review of literature

Wilson, Zachary; Diab, Jason; Putnis, Soni

doi:10.1093/jscr/rjad109

Cited by 3 publications

(6 citation statements)

References 41 publications

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“… 9 The most reported risk factor for stent-migration–associated colonic perforation is diverticulosis, followed by adhesions, hernias, and strictures. 1 In one study that identified 37 cases of colonic perforations secondary to migrated stents, they found that 62% of the cases had diverticular disease, as in our case. 1 Moreover, plastic biliary stent type may affect the risk of bowel perforation.…”

Section: Discussionsupporting

confidence: 57%

“… 1 In one study that identified 37 cases of colonic perforations secondary to migrated stents, they found that 62% of the cases had diverticular disease, as in our case. 1 Moreover, plastic biliary stent type may affect the risk of bowel perforation. Double-pigtail biliary stents may prevent bowel perforation because of their pliable and soft plastic compared with the straight tip of straight biliary stents.…”

Section: Discussionsupporting

confidence: 57%

“… 10 Plastic biliary stents that have migrated to the large intestine and passed through the narrow diameter of the small intestine seldom result in symptoms. 1 In our case, the patient presented with severe lower abdominal pain requiring immediate intervention. Therefore, patients with a history of biliary stenting presenting with abdominal pain should raise the suspicion of stent dislocation and migration.…”

Section: Discussionmentioning

confidence: 68%

“… 2 Migrated biliary stents can lead to complications such as fistula, abscess, obstruction, and gastrointestinal tract perforation. 1 …”

Section: Discussionmentioning

confidence: 99%

“…Biliary stent complications include hemorrhage, stent occlusion, cholangitis, and pancreatitis. 1 Biliary stent migration and dislocation from the common bile duct (CBD) can occasionally occur in patients with biliary stenting, with most stents passing spontaneously with feces without the need for intervention. 2 However, distal bowel perforation by migrated biliary stents occurs rarely and may require endoscopic or surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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Migrated Plastic Biliary Stent Causing Cecal Perforation

Swied,

Al Turk,

Maitar

2024

ACG Case Rep J

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Plastic biliary stents can spontaneously dislodge from the common bile duct and migrate distally into the bowels. Most migrated plastic biliary stents get passed with stools without any complication. However, in rare cases, migrated biliary stents can cause bowel perforation requiring urgent intervention. We report a rare case of a 53-year-old woman presenting with severe lower abdominal pain secondary to migrated plastic biliary stent causing cecal perforation. Computed tomography revealed a radiopaque linear foreign body within the cecum. The patient underwent emergent laparoscopy with stent removal and was discharged 2 days later without long-term complications.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 68%

“… 2 Migrated biliary stents can lead to complications such as fistula, abscess, obstruction, and gastrointestinal tract perforation. 1 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Migrated Plastic Biliary Stent Causing Cecal Perforation

Swied,

Al Turk,

Maitar

2024

ACG Case Rep J

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Case report: Migratory biliary stent resulting in sigmoid colon perforation

Beloy,

Lund,

Van Hell

et al. 2024

Journal of Surgical Case Reports

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Biliary stent insertion during endoscopic retrograde cholangiopancreatography is a therapeutic intervention to relieve obstruction and facilitate flow through the biliary tree. In rare circumstances, these stents can migrate and result in distal gastrointestinal perforation, which may necessitate endoscopic or surgical intervention. We report a case involving a 79-year-old female who presented with peritonitis due to sigmoid colon perforation following biliary stent migration. The stent was placed to treat acute cholangitis with choledocholithiasis. Two weeks following stent placement, gastroenterology attempted scheduled stent removal, but was unable to visualize the stent on endoscopy. Eleven days later, the patient was emergently taken to the operating room for an exploratory laparotomy and a Hartmann’s procedure for stent migration and subsequent sigmoid perforation. No established protocol exists for managing migratory biliary stents to avoid perforations. We emphasize the need for follow-up imaging and individualized clinical decision-making based on patient stability.

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Bowel Perforation Caused by Biliary Stent Migration After ERCP

Wilson,

Ezeani,

Ismail

et al. 2024

Journal of Clinical Gastroenterology

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Goals: This systematic review aims to evaluate the risk factors, clinical features, and outcomes of bowel perforation caused by stent migration after endoscopic retrograde cholangiopancreatography (ERCP). Background: Distal migration of biliary stents can occur after ERCP. Upon migration, most stents pass through the intestine without adverse events; however, bowel perforation has been reported. Study: A comprehensive literature search of PubMed, EMBASE, and Cochrane databases was conducted through October 2023 for articles that reported bowel perforation because of stent migration. Cases of incomplete stent migration and proximal stent migration were excluded. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify full-length articles in English reporting. Results: Of 2041 articles retrieved on the initial search, 92 met the inclusion criteria. A total of 132 cases of bowel perforation occurred due to stent migration after ERCP (56.1% female; average age: 66 y). The median time from initial ERCP to perforation was 44.5 days (IQR 12.5–125.5). Most cases of perforation occurred in the small bowel (64.4%) compared with the colon (34.8%). Stents were mostly plastic (87.1%) with a median diameter of 10 Fr (IQR 8.5–10) and median length of 10.3 cm (IQR 715). Surgical management was pursued in 52.3% and endoscopic management in 42.4%. Bowel resection was required for 25.8% of patients. The overall mortality rate was 17.4%. Conclusion: In summary, this study demonstrates that bowel perforation after ERCP stent migration primarily occurs within 44.5 days and most frequently with a 10 Fr plastic biliary stent. The overall mortality rate was 17.4%. It is important for endoscopists to be mindful of this rare but serious adverse event.

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Migratory biliary stent resulting in colonic perforation: a rare complication and review of literature

Cited by 3 publications

References 41 publications

Migrated Plastic Biliary Stent Causing Cecal Perforation

Migrated Plastic Biliary Stent Causing Cecal Perforation

Case report: Migratory biliary stent resulting in sigmoid colon perforation

Bowel Perforation Caused by Biliary Stent Migration After ERCP

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