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Yagnik VD, Garg P. Re: Small bowel perforation from migrated biliary stent: why did it happen? ANZ J Surg 2021; 91:762-763. [PMID: 33847062 DOI: 10.1111/ans.16520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Vipul D Yagnik
- Department of Surgical Gastroenterology, Nishtha Surgical Hospital and Research Centre, Patan, India
| | - Pankaj Garg
- Department of Colorectal Surgery, Garg Fistula Research Institute, Panchkula, India
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Stassen PM, de Jong DM, Poley JW, Bruno MJ, de Jonge PJ. Prevalence of and risk factors for stent migration-induced duodenal perforation. Endosc Int Open 2021; 9:E461-E469. [PMID: 33655050 PMCID: PMC7895667 DOI: 10.1055/a-1337-2321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The safety of transpapillary biliary drainage by stent placement through endoscopic retrograde cholangiography (ERC) may be compromised by the occurrence of stent migration-induced perforation of the duodenal wall (SMDP). We aimed to assess the prevalence rate, risk factors and clinical course of SMDP. Patients and methods This retrospective cohort study included all patients who underwent an ERC with biliary plastic stent placement, between January 2014 and December 2018. Patients with an SMDP were identified from our endoscopy complication registry. Results 1227 patients underwent an ERC, of whom 629 patients (51 %) with biliary plastic stent placement; in 304 patients (25 %) stents were placed for perihilar strictures. Thirteen patients with SMDP were identified. The prevalence was 2.1 % for patients with biliary plastic stent placement and 4.3 % for patients stented for a perihilar stricture. All SMDPs occurred in patients with a perihilar stricture and with stents ≥ 12 cm (range 12-20 cm). Another potential risk factor was stent insertion into the left liver lobe, which was present in 10 of 13 patients. In 10 of 13 patients, SMDP was clinically suspected. Three of 13 patients were asymptomatic and diagnosed at elective stent retrieval. Eight patients could be endoscopically treated with an over-the-scope clip. Four patients died due to abdominal sepsis despite repeated interventions. Conclusion SMDP is a rare but potentially life-threatening complication of ERC after transpapillary drainage for perihilar biliary strictures. Stents ≥ 12 cm and stent insertion into the left liver lobe may be associated risk factors.
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Affiliation(s)
- Pauline M.C. Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David M. de Jong
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter J.F. de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia. Case Rep Surg 2015; 2015:860286. [PMID: 26273488 PMCID: PMC4529966 DOI: 10.1155/2015/860286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.
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Kumbhari V, Khashab MA. Perforation due to ERCP. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2014. [DOI: 10.1016/j.tgie.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Lee TH, Han JH, Park SH. Endoscopic treatments of endoscopic retrograde cholangiopancreatography-related duodenal perforations. Clin Endosc 2013; 46:522-8. [PMID: 24143315 PMCID: PMC3797938 DOI: 10.5946/ce.2013.46.5.522] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 06/25/2013] [Indexed: 12/13/2022] Open
Abstract
Iatrogenic duodenal perforation associated with endoscopic retrograde cholangiopancreatography (ERCP) is a very uncommon complication that is often lethal. Perforations during ERCP are caused by endoscopic sphincterotomy, placement of biliary or duodenal stents, guidewire-related causes, and endoscopy itself. In particular, perforation of the medial or lateral duodenal wall usually requires prompt diagnosis and surgical management. Perforation can follow various clinical courses, and management depends on the cause of the perforation. Cases resulting from sphincterotomy or guidewire-induced perforation can be managed by conservative treatment and biliary diversion. The current standard treatment for perforation of the duodenal free wall is early surgical repair. However, several reports of primary endoscopic closure techniques using endoclip, endoloop, or newly developed endoscopic devices have recently been described, even for use in direct perforation of the duodenal wall.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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6
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Joo KR, Paik CN, Chung WC, Lee KM, Yang JM. Fracture of Self-Expandable Metal Stent during Endoscopic Removal in Benign Biliary Stricture. Clin Endosc 2013; 46:95-7. [PMID: 23423882 PMCID: PMC3572361 DOI: 10.5946/ce.2013.46.1.95] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 08/25/2012] [Accepted: 08/29/2012] [Indexed: 12/02/2022] Open
Abstract
The endoscopic insertion of the self-expandable metal stent (SEMS) in benign biliary stricture has become an alternative to surgery. Fracture or migration of SEMS can occur rarely as complications. We report a case of fracture of SEMS during endoscopic retrieval in patients with chronic pancreatitis. In this case, broken stent was successfully removed with endoscopic ballooning of bile duct and with a snare device.
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Affiliation(s)
- Kyu Re Joo
- Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea College of Medicine, Suwon, Korea
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7
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Kwon SU, Choi IS, Moon JI, Ra YM, Lee SE, Choi WJ, Yoon DS, Min HS. Comparison of Bile Drainage Methods after Laparoscopic CBD Exploration. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2011; 15:117-22. [PMID: 26421026 PMCID: PMC4582548 DOI: 10.14701/kjhbps.2011.15.2.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 03/28/2011] [Indexed: 11/18/2022]
Abstract
Purpose T-tube is a major procedure that prevents complication by biliary decompression, but which is accompanied by complications. Therefore, several procedures such as ENBD, PTBD, and antegrade biliary stent have been attempted, but with controversies as to which procedure is superior. Also, there are no standard procedures after laparoscopic CBD exploration. We performed this study to ascertain the most appropriate biliary drainage procedure after laparoscopic CBD exploration. Methods From March 2001 to December 2009, 121 patients who underwent Laparoscopic CBD exploration in Gunyang University were included for retrospective analysis. The patients were divided to 4 groups according to type of procedure, and we compared clinical parameters including age and gender, operation time, hospital stay, start of post-operative diet, and complications. Results There was no difference in age, gender, mean operation time, postoperative diet between the 4 groups. Hospital stay in the Stent group was shorter than T-tube group. There were 10 (7%) complications that occurred. Two 2 occurred in the T-tube, 3 in PTBD, and 5 in the Antegrade stent group. There were more complications in Stent group but no significant statistical difference. In 5 cases with remnant CBD stone, a total of 4 (3 PTBD, 1 Stent) was performed by endoscopic CBD stone removal. One T-tube case was removed easily by choledochoscopy through the T-tube. Three migrated and the impacted stents were removed by additional endoscopy. Perioperative biliary leakage (1) and peritonitis (1) post t-tube removal were resolved by conservative treatment. Conclusion T-tube appears to be an appropriate method to patients who are suspected to have remnant CBD stones. Multiple procedures may be performed on a case by case basis such as performing PTBD first in a suspected cholangitis patient.
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Affiliation(s)
- Seong Uk Kwon
- Department of Surgery, Konyang University College of Medicine, Korea
| | - In Seok Choi
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Ju Ik Moon
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Yu Mi Ra
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Sang Eok Lee
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Won Jun Choi
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Dae Sung Yoon
- Department of Surgery, Konyang University College of Medicine, Korea
| | - Hyun Sik Min
- Department of Surgery, Konyang University College of Medicine, Korea
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8
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Lee TH, Park SH, Kim SP, Lee SH, Lee CK, Chung IK, Kim HS, Kim SJ. Spontaneous choledochoduodenal fistula after metallic biliary stent placement in a patient with ampulla of vater carcinoma. Gut Liver 2010; 3:360-3. [PMID: 20431778 PMCID: PMC2852731 DOI: 10.5009/gnl.2009.3.4.360] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 09/03/2009] [Indexed: 11/18/2022] Open
Abstract
Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.
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Affiliation(s)
- Tae Hoon Lee
- Division of Gastroenterology, Department of Internal Medicine, Soon Chun Hyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
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9
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Lee TH, Park DH, Park JY, Lee SH, Chung IK, Kim HS, Park SH, Kim SJ. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation. World J Gastroenterol 2008; 14:3095-7. [PMID: 18494067 PMCID: PMC2712183 DOI: 10.3748/wjg.14.3095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.
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10
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Namdar T, Raffel AM, Topp SA, Namdar L, Alldinger I, Schmitt M, Knoefel WT, Eisenberger CF. Complications and treatment of migrated biliary endoprostheses: A review of the literature. World J Gastroenterol 2007; 13:5397-9. [PMID: 17879415 PMCID: PMC4171335 DOI: 10.3748/wjg.v13.i40.5397] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.
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Affiliation(s)
- Thomas Namdar
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Moorenstrasse 5, Dusseldorf 40225, Germany.
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Miller G, Yim D, Macari M, Harris M, Shamamian P. Retroperitoneal perforation of the duodenum from biliary stent erosion. ACTA ACUST UNITED AC 2006; 62:512-5. [PMID: 16125609 DOI: 10.1016/j.cursur.2005.03.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2004] [Revised: 01/12/2005] [Accepted: 03/09/2005] [Indexed: 12/21/2022]
Abstract
Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.
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Affiliation(s)
- George Miller
- Department of Surgery, New York University School of Medicine, 550 First Avenue, New York, NY 10016, USA
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12
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Sánchez-Tembleque MD, Naranjo Rodríguez A, Ruiz Morales R, Hervás Molina AJ, Calero Ayala B, de Dios Vega JF. [Duodenal perforation due to an endoscopic biliary prosthesis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:225-7. [PMID: 15811264 DOI: 10.1157/13073091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endoscopic biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted therapeutic option in malignant biliary obstructions. However, the procedure is not free of complications. Perforation is one possible complication although it is much less frequent (less than 1%) than pancreatitis (5.4%) or hemorrhage (2%). We present 2 cases of duodenal perforation after placement of a biliary prosthesis through ERCP. Both patients had extensive hilar cholangiocarcinoma. Onset of symptoms of perforation occurred a few hours after placement of the prosthesis and the diagnosis was confirmed by computed tomography and laparotomy. We believe that the mechanism through which perforation occurred was proximal adhesion of the prosthesis to the tumor. This increased the intensity of distal trauma produced by the intraduodenal segment, preventing adaptation of the prosthesis to intestinal peristalsis. A good preventive measure would consist of correctly adjusting the length of the prosthesis in relation to the proximal end of the biliary stenosis.
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Affiliation(s)
- M D Sánchez-Tembleque
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Cerisoli C, Diez J, Giménez M, Oria M, Pardo R, Pujato M. Implantation of migrated biliary stents in the digestive tract. HPB (Oxford) 2003; 5:180-2. [PMID: 18332981 PMCID: PMC2020584 DOI: 10.1080/13651820310015301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. CASE OUTLINES Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. DISCUSSION Biliary stents migrate in 8-10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.
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Affiliation(s)
- C Cerisoli
- Instituto del CallaoBuenos AiresArgentina
| | - J Diez
- Division of Gastrointestinal Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - M Giménez
- Department of Surgery, Hospital A RoffoBuenos AiresArgentina
| | - M Oria
- Department of General Surgery, Division of Laparoscopic Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - R Pardo
- Salvador UniversityBuenos AiresArgentina
| | - M Pujato
- Instituto Argentino de Diagnostico y TratamientoArgentina
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Rosés LL, Ramirez AG, Seco AL, Blanco ES, Alonso DI, Avila S, Lopez BU. Clip closure of a duodenal perforation secondary to a biliary stent. Gastrointest Endosc 2000; 51:487-9. [PMID: 10744829 DOI: 10.1016/s0016-5107(00)70454-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- L L Rosés
- Unidad de Endoscopia, Hospital Xeral, Lugo, Spain
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Affiliation(s)
- S T Amann
- Pancreatic Interventional Services and Therapeutic Endoscopy, North Mississippi Medical Center, Tupelo, Mississippi, USA
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Venbrux AC, Lambert DL, Lillemoe KD, Sofronski MD, Dellon SC. Small-bowel obstruction caused by passage of a self-expanding hexagonal cell nitinol stent in the clinical setting of an inguinal hernia. J Vasc Interv Radiol 1999; 10:359-62. [PMID: 10102203 DOI: 10.1016/s1051-0443(99)70043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- A C Venbrux
- Johns Hopkins Hospital, Baltimore, MD 21287, USA
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17
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Mastorakos DP, Milman PJ, Cohen R, Goldenberg SP. An unusual complication of a biliary stent-small bowel perforation of an incarcerated hernia sac. Am J Gastroenterol 1998; 93:2533-5. [PMID: 9860420 DOI: 10.1111/j.1572-0241.1998.00712.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
We present a case of small bowel perforation after migration of an endoscopically inserted biliary stent inside an incarcerated hernia sac. A review of the literature revealed no other report of stent morbidity associated with hernias. The management and implications are discussed.
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Yoshida EM, Steinbrecher UP. Abdominal pain and rectal bleeding as a complication of biliary stent migration in a liver transplant recipient. Gastrointest Endosc 1998; 47:418-20. [PMID: 9609442 DOI: 10.1016/s0016-5107(98)70234-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- E M Yoshida
- Department of Medicine, the University of British Columbia and the British Columbia Transplant Society, Vancouver, Canada
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20
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Esterl RM, St Laurent M, Bay MK, Speeg KV, Halff GA. Endoscopic biliary stent migration with small bowel perforation in a liver transplant recipient. J Clin Gastroenterol 1997; 24:106-10. [PMID: 9077729 DOI: 10.1097/00004836-199703000-00014] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intestinal perforation from a migrated biliary stent is a rare complication after endoscopic stent placement for benign biliary stricture. We provide the first description of stent migration and distal small-bowel perforation after stent placement for biliary anastomotic stricture in a liver transplant recipient. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic or percutaneous stent placement for benign and malignant biliary strictures. Early diagnosis and treatment of biliary stent migration and subsequent intestinal perforation are essential in transplant patients, in whom immunosuppression sometimes blunts signs and symptoms of intestinal perforation.
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Affiliation(s)
- R M Esterl
- Department of Surgery, University of Texas Health Science Center at San Antonio, 78284-7842, U.S.A
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Tarnasky PR, Cunningham JT, Hawes RH, Hoffman BJ, Uflacker R, Vujic I, Cotton PB. Transpapillary stenting of proximal biliary strictures: does biliary sphincterotomy reduce the risk of postprocedure pancreatitis? Gastrointest Endosc 1997; 45:46-51. [PMID: 9013169 DOI: 10.1016/s0016-5107(97)70301-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatitis after biliary stenting is a rare complication. To reduce this risk, some endoscopists routinely perform biliary sphincterotomy before stenting, but the value of this practice is not established. METHODS The incidence of pancreatitis was reviewed in patients undergoing biliary stenting with and without a biliary sphincterotomy. RESULTS Postprocedure pancreatitis occurred in 4 of 83 (4.8%) patients treated with transpapillary biliary stents. Patients with proximal biliary strictures were at significantly increased risk for postprocedure pancreatitis (4 of 24) versus those with distal or no strictures (0 of 59) (p = 0.006). The four patients with pancreatitis after stenting had not undergone sphincterotomy. Of those treated conservatively, two cases were graded severe (one fatal), and one was mild. The other patient was markedly symptomatic from pancreatitis, but improved dramatically after treatment with a needle-knife sphincterotomy done within 24 hours of the original ERCP. CONCLUSION The risk of pancreatitis following transpapillary biliary stenting is increased in patients with proximal biliary strictures. Such lesions (malignant or benign) may serve as a fulcrum, leading to medial deflection of the stent and compression of the pancreatic orifice. The hypothesis that sphincterotomy may decrease the risk of biliary stent-induced obstructive pancreatitis should be tested in patients with proximal biliary strictures.
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Affiliation(s)
- P R Tarnasky
- Medical University of South Carolina, Digestive Disease Center, Charleston, USA
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