Bacterial Pericarditis Caused by Penetration of a Migrated Biliary Stent from the Lateral Segment of the Liver: A Case Report

A Biliary Stent in the Gallbladder Lumen: Misplacement or Migration?

This case report describes a patient who presented with cholangitis gallbladder sludge, choledocolithiasis, and biliary dilatation. The patient’s magnetic resonance cholangiopancreatography demonstrated that the cystic duct had low and medial insertion on common bile duct. However, the patient presented with abdominal discomfort after the completion of an endoscopic retrograde cholangiopancreatography stenting. Subsequent imaging revealed the proximal stent lying in the gallbladder lumen. The case highlights the importance of having the endoscopists recheck and confirm the positioning of the stent, post-procedure. In addition, it is important to raise awareness among physicians/gastroenterologists regarding the possibility of presence of biliary stent in gallbladder lumen, especially in those patients with a history of endoscopic biliary intervention(s).

The Pierced Colon: When Biliary Stents Go the Wrong Way

Bowel perforation of biliary stents is a rare complication of biliary stenting. We report the successful endoscopic treatment of a 78-year-old man with a straight biliary plastic stent perforating the ascending colon without underlying structural abnormality in the affected segment. Perforation was detected incidentally during computed tomography; the patient had been under continued antibiotic therapy for liver abscess. Stent extraction was performed by using an endoscopic snare; the site of perforation was closed with through-the-scope clips. The patient remained asymptomatic. In addition, we reviewed published cases of perforated biliary stents and outlined that most perforations are caused by straight plastic stents.

Editorial for the Special Issue "Emergency Medicine and Emergency Room Medical Issues"

Together with the "law of entropy", two of the main reasons for the risk of burnout among physicians who work in emergency departments around the world are the variety of clinical issues presented by patients and the absence of guidelines for managing most of them [...].

Proximal Biliary Stent Migration Causing Cardiac Tamponade

Plastic biliary stents are commonly placed during endoscopic retrograde cholangiopancreatography for various indications, and stent-related complications are uncommon. We describe a case in which a plastic biliary stent migrated proximally through the liver capsule and diaphragm after endoscopic retrograde cholangiopancreatography, leading to pericardial effusion and cardiac tamponade. It is important for clinicians managing patients with biliary stents to be aware of this significant adverse event.

Cardiac tamponade and septic pericarditis caused by biliary stent migration

In patients with biliary or pancreatic disease, endoscopic retrograde cholangiopancreatography (ERCP) is a common and important therapeutic and diagnostic procedure. Stent migration is a possible complication occurring in approximately 5-10% of cases. This case presents a 47-year-old male with chest pain and found to have biliary stent migration to the pericardial sac causing septic pericarditis and cardiac tamponade. Highlighting this devastating complication, this case demonstrates an opportunity for emergency physicians (EP) to diagnose and monitor patients for post-operative and post-procedural complications. In the emergency department, EPs are well positioned to use ultrasound as a diagnostic and monitoring tool for cardiac tamponade.