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AlZoubi L, Badwan B, Fayyad A. Ileal perforation due to migrated biliary stent: A case report. Arab J Gastroenterol 2023; 24:180-182. [PMID: 37673707 DOI: 10.1016/j.ajg.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
Ileal perforation caused by the migration of a biliary stent is a rare complication that can occur during endoscopic stent placement for benign or malignant biliary tract diseases. The current study reports the case of a 45-year-old woman with a history of Endoscopic retrograde cholangiopancreatography (ERCP) in which a migrated biliary stent resulted in an ileal perforation.
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Affiliation(s)
- Lujain AlZoubi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Basem Badwan
- General Surgery, Al-Basheer Hospital, Amman, Jordan
| | - Ahmad Fayyad
- General Surgery, Al-Basheer Hospital, Amman, Jordan
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2
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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.
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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
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Tsang CLN, O'Neill RS, Joseph CM, Palasovski T. Small Bowel Perforation Secondary to Biliary Stent Migration in an Incarcerated Inguinal Hernia. Cureus 2020; 12:e7268. [PMID: 32292679 PMCID: PMC7153812 DOI: 10.7759/cureus.7268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We describe the case of a 90-year-old female who presented with signs of a strangulated inguinal hernia. Further history revealed a paired biliary-pancreatic stent insertion three years prior for ascending cholangitis and a long-standing asymptomatic right inguinal hernia. Biochemistry revealed a slightly elevated C-reactive protein level of 65 mmol/L, but was otherwise unremarkable. Abdominal CT demonstrated two plastic biliary stents within an incarcerated right inguinal hernia. At the time of surgery, a 3-mm perforation due to the stents was identified in the small bowel within the hernia. The stents were retrieved via an enterotomy that was subsequently repaired with full-thickness interrupted sutures. A tissue-suture repair of the inguinal hernia was performed due to significant contamination of enteric contents in the operative field. The patient had an unremarkable recovery and was discharged four days after her operation. This is a very rare acute presentation of stent migration with only a handful of such reported cases in the literature. With the rising number of endoscopic biliary stenting procedures, these complications are likely to increase, and clinicians need to be aware of this possibility in patients with pre-existing hernias.
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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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5
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Complications of Biliary and Gastrointestinal Stents: MDCT of the Cancer Patient. AJR Am J Roentgenol 2012; 199:W187-96. [DOI: 10.2214/ajr.11.7145] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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6
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Hutchins GF, Gravning SL. An uncommon complication of ERCP. Gastrointest Endosc 2012; 75:699-701. [PMID: 22341124 DOI: 10.1016/j.gie.2011.10.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Accepted: 10/24/2011] [Indexed: 02/08/2023]
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Pérez Roldán F, González Carro PS, Legaz Huidobro ML, Roncero García-Escribano O, Sánchez-Manjavacas Muñoz N, Ynfante Ferrús M, Ruíz Carrillo F, Villafáñez García MC. [New techniques to extract impacted partially covered metallic biliary stents]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 32:489-94. [PMID: 19577341 DOI: 10.1016/j.gastrohep.2009.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Accepted: 03/05/2009] [Indexed: 10/20/2022]
Abstract
One of the problems affecting metallic biliary stents is the difficulty of removing them, especially after a period of months or if they have migrated. Several approaches have been used to remove both covered and uncovered stents, although with different degrees of effectiveness. We report two new approaches to removing partially covered stents that migrated proximally and that impacted in the papillary area and distal common bile duct. One stent was removed by papillectomy and the other by using duodenoscopy-guided controlled radial expansion balloon dilation. In both cases, the stents were removed without severe complications for the patient, leaving a good caliber in the stenosis.
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Affiliation(s)
- Francisco Pérez Roldán
- Sección Aparato Digestivo, Hospital General La Mancha Centro, Alcázar de San Juan, Castilla-La Mancha, España.
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Rerknimitr R, Naprasert P, Kongkam P, Kullavanijaya P. Trimming a metallic biliary stent using an argon plasma coagulator. Cardiovasc Intervent Radiol 2007; 30:534-6. [PMID: 16933157 DOI: 10.1007/s00270-006-0013-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distal migration is one of the common complications after insertion of a covered metallic stent. Stent repositioning or removal is not always possible in every patient. Therefore, trimming using an argon plasma coagulator (APC) may be a good alternative method to solve this problem. METHODS Metallic stent trimming by APC was performed in 2 patients with biliary Wallstent migration and in another patient with esophageal Ultraflex stent migration. The power setting was 60-100 watts with an argon flow of 0.8 l/min. OBSERVATIONS The procedure was successfully performed and all distal parts of the stents were removed. No significant collateral damage to the nearby mucosa was observed. CONCLUSIONS In a patient with a distally migrated metallic stent, trimming of the stent is possible by means of an APC. This new method may be applicable to other sites of metallic stent migration.
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Affiliation(s)
- Rungsun Rerknimitr
- Gastroenterology Unit, Department of Internal Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10310, Thailand.
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Guda NM, Freeman ML. Endoscopic transection of distally migrated biliary self-expanding metallic stents by using argon plasma coagulation: a report of 2 cases (with video). Gastrointest Endosc 2006; 63:512-4. [PMID: 16500412 DOI: 10.1016/j.gie.2005.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2005] [Accepted: 11/02/2005] [Indexed: 12/10/2022]
Affiliation(s)
- Nalini M Guda
- GI Consultants, Ltd, St Luke's Medical Center, Milwaukee, Wisconsin, USA
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Kuo MD, Lopresti DC, Gover DD, Hall LD, Ferrara SL. Intentional Retrieval of Viabil Stent-Grafts from the Biliary System. J Vasc Interv Radiol 2006; 17:389-97. [PMID: 16517789 DOI: 10.1097/01.rvi.0000194867.86371.0b] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The present report describes the intentional retrieval of six Viabil stent-grafts from the biliary system. The six stent-grafts were successfully removed from five patients with a mean time from placement to retrieval of 38 days. Successful retrieval was independent of underlying disease etiology and included strictures associated with benign disease, malignant disease, disease of unknown etiology, and stent-graft misplacement. There were no complications resulting from stent-graft retrieval. Intentional removal of Viabil stent-grafts is technically feasible. Further study is necessary to establish its potential role in the management of biliary disease.
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Affiliation(s)
- Michael D Kuo
- Department of Radiology, San Diego, California 92103, USA. mkuo@ucsd
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Gupta A, Frazer C, Brennan F. Percutaneous retrieval of a proximally migrated common bile duct endoprosthesis from the right anterior duct. AUSTRALASIAN RADIOLOGY 2002; 46:325-8. [PMID: 12196248 DOI: 10.1046/j.1440-1673.2002.01071.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Common bile duct (CBD) endoprostheses that are inserted at endoscopy are in routine clinical use to decompress the obstructed biliary tract. This case describes the proximal migration of a CBD endoprosthesis into the right anterior duct. An attempt at endoscopic retrieval failed. The endoprosthesis was retrieved by a percutaneous transhepatic approach using an Amplatz goose-neck snare. To the best of our knowledge, use of the Amplatz goose-neck snare has not been reported for this application.
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Affiliation(s)
- Ashu Gupta
- Department of Radiology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
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Merkle EM, Boll DT, Weidenbach H, Brambs HJ, Gabelmann A. Ability of MR cholangiography to reveal stent position and luminal diameter in patients with biliary endoprostheses: in vitro measurements and in vivo results in 30 patients. AJR Am J Roentgenol 2001; 176:913-8. [PMID: 11264077 DOI: 10.2214/ajr.176.4.1760913] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Our goal was to evaluate the ability of MR cholangiography to show stent position and luminal diameter in patients with biliary endoprostheses. MATERIALS AND METHODS Susceptibility artifacts were evaluated in vitro in three different stent systems (cobalt alloy-based, nitinol-based, and polyethylene) using two breath-hold sequences (rapid acquisition with relaxation enhancement, half-Fourier acquisition single-shot turbo spin echo) on a 1.5-T MR imaging system. The size of the stent-related artifact was measured, and the relative stent lumen was calculated. In vivo stent position and patency were determined in 30 patients (10 cobalt alloy-based stents, five nitinol-based stents, and 15 polyethylene stents). RESULTS In vitro, the susceptibility artifact of the cobalt stent caused complete obliteration of the stent lumen. The relative stent lumens of the nitinol-based and polyethylene stents were 38-50% and 67-100%, respectively. In vivo, all stents were patent at the time of imaging. The position of the cobalt alloy-based stent could be determined in nine of 10 patients, but stent patency could not be evaluated. Stent position of nitinol stents could not be adequately evaluated in any of the five patients, and internal stent diameter could be visualized in only one patient. In nine of 15 patients, the fluid column within the implanted polyethylene stent was seen on MR cholangiography. CONCLUSION The internal stent lumen could be visualized in most patients with an indwelling polyethylene stent, but not in patients with cobalt alloy- or nitinol-based stents.
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Affiliation(s)
- E M Merkle
- Department of Radiology, University Hospitals of Ulm, Robert Koch Str. 8, 89081 Ulm, Germany
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Aultman CJ, Soares G, Grayson DE. Transnasal removal of a biliary endoprosthesis with percutaneous transhepatic biliary catheter replacement. J Vasc Interv Radiol 2001; 12:257-60. [PMID: 11265892 DOI: 10.1016/s1051-0443(07)61834-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The authors describe a novel fluoroscopically guided transnasal technique for removal of an endoscopically placed endobiliary prosthesis (EBP). A case in which the approach was applied is used to demonstrate its indications, clinical utility and possible benefits. The procedure entails simultaneous percutaneous replacement of the EBP with an internal/external biliary catheter over a through-and-through transhepatic/transnasal access wire. A comparison of the technique's limitations with those of traditional approaches for endoscopic or percutaneous EBP removal and replacement is presented.
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Affiliation(s)
- C J Aultman
- Department of Radiology, Wilford Hall Medical Center, Lackland AFB, TX 78236-5300, USA
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Mizukami Y, Saito H, Obara T, Arisato S, Nakano Y, Sakurai Y, Izawa T, Kohgo Y. Temporary use of an accuflex stent for unextractable common bile duct stones. J Gastroenterol Hepatol 2000; 15:680-3. [PMID: 10921425 DOI: 10.1046/j.1440-1746.2000.02200.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endoscopic management has become the main therapeutic approach for the extraction of common bile duct (CBD) stones, and successful removal can be achieved in 80-90% patients using conventional balloon and basket techniques. However, if it is difficult to completely fragment a stone, or to clear the CBD, which may occur for a variety of reasons, the therapeutic problem will remain. When bile duct stones can not be removed, a viable management option is to place a biliary stent to ensure drainage. However, recent studies of long-term biliary stenting, with a plastic stent, showed a relatively high rate of morbidity and mortality. We report an alternative, unique treatment for unextractable common bile duct stones, using the temporal placement of an expandable metallic stent (EMS) to facilitate passage of fragments through the papilla.
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Affiliation(s)
- Y Mizukami
- Department of Gastroenterology, Asahikawa Kosei General Hospital, Asahikawa Medical College, Japan.
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