1
|
Alkhawaldeh IM, Shattarah O, AlSamhori JF, Abu‐Jeyyab M, Nashwan AJ. Late small bowel perforation from a migrated double plastic biliary stent: A case report and a review of literature of 85 cases from 2000 to 2022. Clin Case Rep 2023; 11:e7425. [PMID: 38028080 PMCID: PMC10658557 DOI: 10.1002/ccr3.7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case highlights the importance of considering stent migration as a possible cause of intestinal perforation and the need for prompt surgical intervention. Abstract Endo-biliary stent displacement is rare but can cause intestinal perforation. An 85-year-old woman with a history of ERCPs and biliary stents experienced stomach pain and vomiting. She was diagnosed with small bowel perforation from migrated stents and underwent emergency laparotomy, bowel resection, and tension-free stapled anastomosis.
Collapse
Affiliation(s)
| | - Osama Shattarah
- General Surgery Department, School of MedicineMutah UniversityAl‐KarakJordan
| | | | | | | |
Collapse
|
2
|
Zorbas KA, Ashmeade S, Lois W, Farkas DT. Small bowel perforation from a migrated biliary stent: A case report and review of literature. World J Gastrointest Endosc 2021; 13:543-554. [PMID: 34733414 PMCID: PMC8546564 DOI: 10.4253/wjge.v13.i10.543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/10/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%. CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention. CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.
Collapse
Affiliation(s)
| | - Shane Ashmeade
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - William Lois
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - Daniel T Farkas
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| |
Collapse
|
3
|
Vaz-Pereira R, Ferreira C, Monteiro A, Guidi G, Martins D, Pinto-de-Sousa J. Intestinal perforation on an incarcerated incisional hernia secondary to an ingested foreign body. Report of a rare case. J Surg Case Rep 2021; 2021:rjab348. [PMID: 34408841 PMCID: PMC8364787 DOI: 10.1093/jscr/rjab348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/22/2021] [Indexed: 11/21/2022] Open
Abstract
Ingestion of foreign bodies (FBs) is common and rarely has consequences for the patient, but sometimes it can originate gastrointestinal perforation and lead to devastating consequences if unrecognized. Therefore, whenever present, bowel perforation demands immediate surgical treatment. An 89-year-old woman with an incarcerated incisional hernia, whose imaging study was consistent with intestinal occlusion and perforation within the hernia sac was treated at our hospital. A segmental enterectomy and direct correction of the hernial defect were performed. A perforation in the mesenteric border due to a FB, which seemed to be a toothpick, was identified in the surgical specimen. Nine months after surgery, the patient was without complaints, with adequate healing, and without evidence of hernial recurrence. To the best of our knowledge, this is the first case of intestinal perforation on an incarcerated incisional hernia, due to an ingested FB, reported in the literature.
Collapse
Affiliation(s)
- Ricardo Vaz-Pereira
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| | - Cátia Ferreira
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| | - Ana Monteiro
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| | - Gonçalo Guidi
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| | - Daniela Martins
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| | - João Pinto-de-Sousa
- Department of General Surgery, Centro Hospitalar De Trás-Os-Montes E Alto Douro, E.P.E, Av. Noruega, 5000-508 Vila Real, Portugal
| |
Collapse
|
4
|
Vafaeimanesh J, Tghavi R, Madani S. Acute Abdomen in a Patient with a History of Pulmonary Tuberculosis and Endoscopic Retrograde Cholangio-Pancreatography Due to Common Bile Duct Stones. Middle East J Dig Dis 2020; 12:211-213. [PMID: 33062227 PMCID: PMC7548091 DOI: 10.34172/mejdd.2020.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jamshid Vafaeimanesh
- Gastroenterologist, Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran.,Qom Gastroenterology and Hepatology Disease Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Rohollah Tghavi
- Surgeon, Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | - Saeed Madani
- Surgeon, Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| |
Collapse
|
5
|
Nishiwaki M, Mizuno C, Yano K, Oya H, Amano I, Matsumoto J, Tanaka I, Sawai N, Mizuno M, Shima T, Miyamoto Y, Okanoue T. Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula. Intern Med 2018; 57:351-355. [PMID: 29093393 PMCID: PMC5827315 DOI: 10.2169/internalmedicine.9054-17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
An 85-year-old woman underwent endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. Selective bile duct cannulation was unsuccessful because of periampullary diverticula (PAD). A pancreatic spontaneous dislodgement stent (PSDS) (5F diameter, 3 cm, straight type) was inserted to prevent post-ERCP pancreatitis. Three days after ERCP, she complained of abdominal pain, and computed tomography revealed retroperitoneal perforation because of PSDS migration to the PAD. If the papillary orifice is observed at the diverticular rim or in the diverticula, a pigtailed PSDS on the duodenal side or flanged stent on the pancreatic ductal side should be inserted in order to prevent this rare adverse event.
Collapse
Affiliation(s)
- Masatake Nishiwaki
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Chiemi Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Kota Yano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Hirohisa Oya
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Ichiro Amano
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Junko Matsumoto
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Izumi Tanaka
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Naoki Sawai
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Masayuki Mizuno
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | - Toshihide Shima
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| | | | - Takeshi Okanoue
- Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Japan
| |
Collapse
|
6
|
Biliary stent migration: a brief review of potential complications and possible etiological factors. Am J Ther 2015; 21:e124-9. [PMID: 23508199 DOI: 10.1097/mjt.0b013e3182491dd9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Biliary endoprostheses continue to demonstrate their utility and simplicity in daily therapeutic endoscopy. However, the transient nature of these foreign bodies also underscores their potential detrimental effects even after successful deployment. Stent related factors, such as type, length and caliber offer potential avenues to minimize the risk of migration. However, a patient related factor such as the presence of prior abdominal surgeries makes it paramount for endoscopists to ascertain the location of a migrated stent. There is a ripe niche for continued research and development in biodegradable stents.
Collapse
|
7
|
Mady RF, Niaz OS, Assal MM. Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess. BMJ Case Rep 2015; 2015:bcr2014206805. [PMID: 25870211 PMCID: PMC4401935 DOI: 10.1136/bcr-2014-206805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 01/30/2023] Open
Abstract
Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.
Collapse
|
8
|
Konstantinidis C, Varsos P, Kympouris S, Volteas S. Migrated biliary plastic stent causing double sigmoid colon perforation. J Surg Case Rep 2014; 2014:rju134. [PMID: 25487372 PMCID: PMC4258704 DOI: 10.1093/jscr/rju134] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A female patient was admitted to our hospital with sigmoid colon perforation caused by migrated biliary plastic stent, which was placed 2 months ago for the treatment of choledocholithiasis. The patient underwent sigmoid colon resection with primary anastomosis and was discharged on seventh postoperative day in good general condition.
Collapse
Affiliation(s)
| | - Panagiotis Varsos
- Surgical Department, Hippocratio General Hospital of Athens, Athens, Greece
| | - Sotirios Kympouris
- Surgical Department, Hippocratio General Hospital of Athens, Athens, Greece
| | - Spyridon Volteas
- Surgical Department, Hippocratio General Hospital of Athens, Athens, Greece
| |
Collapse
|
9
|
El Maksoud WA. Biliary stent migration causing incarceration and perforation of the ileum in a previously uncomplicated inguinal hernia: Report of a case and review of literature. HELLENIC JOURNAL OF SURGERY 2014; 86:47-49. [DOI: 10.1007/s13126-014-0094-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
|
10
|
Issa H, Nahawi M, Bseiso B, Al-Salem A. Migration of a biliary stent causing duodenal perforation and biliary peritonitis. World J Gastrointest Endosc 2013; 5:523-526. [PMID: 24147198 PMCID: PMC3797907 DOI: 10.4253/wjge.v5.i10.523] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/08/2013] [Accepted: 09/04/2013] [Indexed: 02/05/2023] Open
Abstract
Migration of endoscopically placed biliary stents is a well-recognized complication of endoscopic retrograde cholangiopancreatography. Less than 1% of migrated stents however cause intestinal perforation. We present a case of a migrated biliary stent that resulted in duodenal perforation and biliary peritonitis.
Collapse
|
11
|
Takano S, Fukasawa M, Sato T, Takahashi E, Kadokura M, Shindo H, Enomoto N. Migration of pancreatic spontaneous dislodgement stent to the appendix. Dig Endosc 2012; 24:481. [PMID: 23078450 DOI: 10.1111/j.1443-1661.2012.01337.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Shinichi Takano
- First Department of Medicine and Department of Endoscopy, Faculty of Medicine, University of Yamanashi, Yamanashi, Japan
| | | | | | | | | | | | | |
Collapse
|
12
|
Tolan HK, Sriprayoon T, Akaraviputh T. Unusual penetration of plastic biliary stent in a large ampullary carcinoma: A case report. World J Gastrointest Endosc 2012; 4:266-8. [PMID: 22720129 PMCID: PMC3377870 DOI: 10.4253/wjge.v4.i6.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic biliary stenting is a well-established treatment of choice for many obstructive biliary disorders. Commonly used plastic endoprostheses have a higher risk of clogging and dislocation. Distal stent migration is an infrequent complication. Duodenum is the most common site of a migrated biliary stent. Intestinal perforation can occur during the initial insertion or endoscopic or percutaneous manipulation, or as a late consequence of stent placement. A 52-year-old male who presented with obstructive jaundice underwent endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. However, jaundice did not improve and he then underwent ERCP which revealed the plastic stent penetrating the ampullary tumor into the duodenal wall causing malfunction of the stent. A new plastic stent was inserted and the patient underwent Whipple’s operation. He is currently doing well after the operation.
Collapse
Affiliation(s)
- H Kerem Tolan
- H Kerem Tolan, Tassanee Sriprayoon, Thawatchai Akaraviputh, Department of Surgery, Division of General Surgery, Minimally Invasive Surgery Unit, Siriraj Gastrointestinal Endoscopy Center, Mahidol University, Bangkok 10700, Thailand
| | | | | |
Collapse
|
13
|
Abela JE, Anderson JE, Whalen HR, Mitchell KG. Endo-biliary stents for benign disease: not always benign after all! Clin Pract 2011; 1:e102. [PMID: 24765343 PMCID: PMC3981400 DOI: 10.4081/cp.2011.e102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 10/18/2011] [Indexed: 12/15/2022] Open
Abstract
This case report describes the presentation, management and treatment of a patient who suffered small bowel perforation due to the migration of his biliary stent which had been inserted for benign disease.
Collapse
Affiliation(s)
| | - John E Anderson
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - Henry R Whalen
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | | |
Collapse
|
14
|
Escudero E, Eduardo Dolan M, Grassano L, Ferrer E, Gil Pomar J. [Intestinal perforation due to migration of a biliary prosthesis: Mini-invasive treatment]. GASTROENTEROLOGIA Y HEPATOLOGIA 2010; 33:684-5. [PMID: 20630623 DOI: 10.1016/j.gastrohep.2010.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 04/01/2010] [Indexed: 10/19/2022]
|
15
|
Bagul A, Pollard C, Dennison AR. A review of problems following insertion of biliary stents illustrated by an unusual complication. Ann R Coll Surg Engl 2010; 92:W27-31. [PMID: 20501006 DOI: 10.1308/147870810x12659688852239] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. METHODS A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. FINDINGS Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.
Collapse
Affiliation(s)
- Atul Bagul
- HPB Department, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
| | | | | |
Collapse
|
16
|
Hunter K, Siddiqui T, Komolafe O, Chong D. Colonic perforation secondary to migrated biliary stent. Case report of an unusual complication, and literature review. Scott Med J 2010. [DOI: 10.1258/rsmsmj.55.1.57i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endoscopic stents are widely used to facilitate biliary drainage in hepatic, biliary and pancreatic conditions. Migration of the stent is a potentially serious complication. We report a case of migration of a biliary stent to the sigmoid colon at which point the stent perforated the colon and become lodged subcutaneously. The patient was managed successfully by local exploration to retrieve the stent without bowel resection. We also review the literature on complications caused by migrated biliary stents.
Collapse
Affiliation(s)
- K Hunter
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - T Siddiqui
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Oo Komolafe
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Dcs Chong
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| |
Collapse
|
17
|
Akbulut S, Cakabay B, Ozmen CA, Sezgin A, Sevinc MM. An unusual cause of ileal perforation: Report of a case and literature review. World J Gastroenterol 2009; 15:2672-4. [PMID: 19496201 PMCID: PMC2691502 DOI: 10.3748/wjg.15.2672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [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
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.
Collapse
|
18
|
Culnan DM, Cicuto BJ, Singh H, Cherry RA. Percutaneous retrieval of a biliary stent after migration and ileal perforation. World J Emerg Surg 2009; 4:6. [PMID: 19183489 PMCID: PMC2642780 DOI: 10.1186/1749-7922-4-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/31/2009] [Indexed: 02/07/2023] Open
Abstract
We present a case of a migrated biliary stent that resulted in a distal small bowel perforation, abscess formation and high grade partial small bowel obstruction in a medically stable patient without signs of sepsis or diffuse peritonitis. We performed a percutaneous drainage of the abscess followed by percutaneous retrieval of the stent. The entero-peritoneal fistula closed spontaneously with a drain in place. We conclude, migrated biliary stents associated with perforation distal to the Ligament of Trietz (LOT), may be treated by percutaneous drainage of the abscess and retrieval of the stent from the peritoneal cavity, even when associated with a large intra-abdominal abscess.
Collapse
Affiliation(s)
- Derek M Culnan
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Bryan J Cicuto
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Harjit Singh
- Department of Radiology, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Robert A Cherry
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| |
Collapse
|
19
|
Senosiáin M, Senent C, Nogales O, Hernando A, González Asanza C, Menchén P. [Sigmoid perforation secondary to spontaneous migration of a plastic biliary prosthesis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2008; 31:317. [PMID: 18448064 DOI: 10.1157/13119886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
|
20
|
Intra-peritoneal duodenal perforation caused by delayed migration of endobiliary stent: a case report. Int J Surg 2006; 6:478-80. [PMID: 19059151 DOI: 10.1016/j.ijsu.2006.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 06/06/2006] [Accepted: 06/14/2006] [Indexed: 01/13/2023]
Abstract
Endoscopic biliary stenting is an accepted modality of palliation of malignant biliary obstructions. Delayed stent migration causing intra-peritoneal perforation of duodenum, is a rare life threatening complication. Proximal adhesion of stent to the tumor is believed to increase the intensity of distal trauma produced by the intra-duodenal segment, preventing its adaptation to intestinal peristalsis and causing perforation. Low bacterial load and containment of leak by gut and omentum blunts the clinical features. Unexplained abdominal discomfort in stented patients should alert the clinician to its possibility, irrespective of the delay between stent placement and onset of symptoms. Early diagnosis and treatment is desirable but aggressive surgical management with gastro-biliary diversion, tube duodenostomy, antibiotics, bowel rest and parenteral alimentation followed by distal alimentation, may make up for the delay in those presenting late. A case of 7 days old intra-peritoneal duodenal perforation following delayed migration (3 months) of endobiliary stent presenting with atypical features is reported. Stent's distal end was protruding through the duodenum with its proximal end in CBD. Mortality, fistulization, abscesses and sepsis are known complications but were not observed in our case. Much of the management can be done minimally invasively, if recognized early.
Collapse
|