Complications and treatment of migrated biliary endoprostheses: A review of the literature

Migrated biliary stent into the portal vein: a case report

Biliary stent insertion is a well-established treatment of bile duct obstruction. Stent migration is a late-onset complication and can be life-threatening. We present a case of proximal biliary stent migration to the portal vein. An upper endoscopy was performed, and the biliary stent was retracted. Bleeding was seen from the papilla of Vater. The hepatoduodenal ligament was explored, and the common bile duct was found fully adherent to the portal vein, with a fistula between the common bile duct and the portal vein. The patient underwent surgery with extrahepatic bile duct resection and hepaticoduodenostomy. The patient survived and was discharged without surgical postoperative complications on postoperative Day 8.

Bowel Obstruction From Biliary Stent Migration: An Unusual Case of Abdominal Pain

Endoscopic biliary stent placement is an important procedure that is commonly done in patients with malignant obstruction of the biliary tree. However, it can also be done to relieve non-maligant obstructions short term until more curative surgical interventions can be performed. There are two main types of stents used for these procedures: self-expanding metal stents (SEMSs) and plastic stents. Each of these stent types has different indications, and determining the correct stent for each individual patient is important. Here, we present a case of a 73-year-old female who presented with abdominal pain due to small bowel obstruction caused by a dislodged biliary duct stent. We hope to promote more focus on selecting the right stent type for each patient and encouraging follow-up visits after placement, especially for those with a history of medical noncompliance.

Sems Sensibility: Biliary Stent Migration into the Oesophagus

Endoprostheses are commonly used in the treatment of biliary and pancreatic disorders. Fully-covered metal stents are intended for the palliation of malignant strictures in the biliary tree. We report a case of a patient affected by cancer of the pancreas who was treated with a proximal metallic biliary stent. The stent migrated to the oesophagus and was endoscopically removed. Proximal migration, although rare, should be kept in mind as a potential complication of the procedure.

CT imaging features of bile duct stent complications

Biliary stents have been widely used to treat both malignant and benign biliary obstruction. Biliary stenting serves as a temporary measure to maintain ductal patency and promote bile drainage. Biliary decompression can help relieve clinical symptoms of pain, obstructive jaundice, pruritis, fat malabsorption, and failure to thrive and prevent disease progression, such as secondary biliary cirrhosis and end-stage liver failure. Endoscopic placement of biliary endoprosthesis is a minimally invasive procedure well tolerated by most patients but is not without problems. Multiple early and late complications have been reported in the literature and Computed Tomography (CT) is the most used modality to assess normal positions and evaluate patients suspected of stent complications. The aim of this article is to provide a review various of biliary stent related complications, as seen on CT. Current literature on risk factors, diagnosis and management is also discussed.

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

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.

Ileal perforation due to migrated biliary stent: A case report

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.

Minimally invasive management of an ascending colonic perforation secondary to distal biliary stent migration: a multidisciplinary, novel laparoendoscopic approach

Endobiliary stents placed for benign and malignant indications can spontaneously dislocate from the biliary system and migrate to the distal gastrointestinal tract. Stent migration can result in gastrointestinal perforation, with the most common locations in the sigmoid and distal colon, and may require surgical intervention. We describe the case of a 60-year-old female presenting with an ascending colonic perforation secondary to a dislodged plastic biliary stent placed for palliation of her gallbladder carcinoma. The patient was managed with a combined laparoendoscopic approach by a multidisciplinary team—gastroenterology performed an endoscopic stent retrieval and colorectal surgery identified the location of the perforation laparoscopically and performed colonic serosal repairs. The patient had an uneventful postoperative course and was discharged on postoperative day 4. This case demonstrates a novel minimally invasive laparoendoscopic approach at a high-volume academic center for the treatment of ascending colonic perforation secondary to biliary stent migration.

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

Endoscopic biliary stent insertion is a well-established procedure that is indispensable in the management of various benign and malignant biliary disorders, and one that helps prevent mortality related to invasive surgical procedures. We report a rare case of the distal migration of a biliary stent outside the abdomen to the pericardium, inducing constrictive pericarditis and septic shock. This case alerts clinicians to be aware of potential adverse events that can lead to unfavorable patient outcomes. Such adverse events can be effectively avoided through early detection and intervention.

Colonic diverticular perforation by a migrated biliary stent: A case report with literature review

RATIONALE

Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature.

PATIENTS CONCERNS

A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago.

DIAGNOSES

Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis.

INTERVENTIONS

Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed.

OUTCOMES

On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications.

LESSONS

Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.

Successful endoscopic closure with an over-the-scope clip for sigmoid colon perforation due to bile duct stent migration

An 86-year-old woman presented with a history of endoscopic papillary sphincterotomy for bile duct stones and diverticulitis. The patient was admitted as an emergency case of acute cholangitis due to choledocholithiasis, underwent endoscopic bile duct stenting, and was discharged with a plan for endoscopic lithotripsy. One month later, the patient was readmitted owing to abdominal pain. Abdominal computed tomography at admission showed that the bile duct stent had migrated to the sigmoid colon and the presence of a small amount of extraintestinal gas, suggesting a colonic perforation. Lower gastrointestinal endoscopy showed adhesions and intestinal stenosis in the sigmoid colon, probably after diverticulitis, and the bile duct stent that had perforated the same site. The stent was removed and endoscopic closure of the perforation was performed using an over-the-scope clip. Abdominal computed tomography 8 days after the closure showed no extraintestinal gas. The patient resumed eating and was discharged on the 14th day of admission. There was no recurrence of abdominal pain. Endoscopic closure of sigmoid colon perforation due to bile duct stent migration using an over-the-scope clip has not been reported thus far, and it may be a new treatment option in the future.

Small bowel perforation from a migrated biliary stent: A case report and review of literature

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.

Successful Removal of a Biliary Stent in the Jejunum Using Double-Balloon Enteroscopy

Background:

Plastic biliary stent placement has been widely used as a safe approach for the management of hilar neoplasms or the dilation of benign biliary obstruction. Despite the complexity of this procedure, this approach is followed by a few complications. The incidence rate of stent migration is about 10%. In a majority of cases, the migrated stents are retained within the gastrointestinal tract and pass through the intestine with no complication or need for medical intervention.

Case Report:

In this paper, we described the case of the migrated biliary stent with prolonged abdominal pain, which was removed successfully by using double-balloon.

Conclusion:

In the case of patient with prolonged abdominal pain and previous history of biliary stent placement, migration of stent should be considered as differential diagnosis and Double-Balloon Enteroscopy can be a safe approach in those cases.

Biliary stent migration: why, how, and what?

BACKGROUND AND PURPOSE

The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents.

PATIENTS AND METHODS

Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed.

RESULTS

Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps.

CONCLUSION

Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.

Biliary stent migration as a rare cause of ileal perforation

The incidence of biliary stent migration is low, and most cases are asymptomatic, with elimination of the piece by the feces. We report the case of a patient with an ileal perforation secondary to a plastic biliary stent migration. Intestinal perforation due to stent migration is an extremely rare complication, being mostly located at duodenum. Patients with previous surgeries, diverticulosis or abdominal wall hernias have a higher risk of complications in case of prosthetic migration, that is the reason why they require special attention and follow-up.

Endoscopic or Conservative Management of Iatrogenic Duodenal Perforations Caused by Long Plastic Biliary Stent Distal Migration

Plastic biliary stents are associated with rare but potentially life-threatening distal stent migration. We present 4 patient cases with distal migration, whereas the proximal aspect remained in the bile duct. Time to stent migration ranged from 1 week to 2 months. Stent migration caused contralateral duodenal wall perforation; 2 underwent endoscopic over-the-scope clip placement for defect closure. All required previous stent removal and stent exchange. This case series highlights that proximal stricture and longer stents have higher migration risk, also shown in the literature. We also show that duodenal perforation can successfully be managed endoscopically with an over-the-scope clip.

Post ERCP gastrointestinal hemorrhage: An unusual complication of migrated biliary stent

Endoscopic biliary stenting is an established modality of managing benign and malignant obstructive disorders of biliary tract. Complications associated with biliary stents though uncommon are on the rise. We report a case of migrated biliary plastic stent presenting as gastro-inetstinal hemorrhage, which was managed successfully by endoscopic technique avoiding any major surgery.

Risk factors for distal migration of biliary plastic stents and related duodenal injury

BACKGROUND

The risk factors of duodenal injury from distal migrated biliary plastic stents remain uncertain. The aim of this study was to determine the risk factors of distal migration and its related duodenal injury in patients who underwent placement of a single biliary plastic stent for biliary strictures.

METHODS

We retrospectively reviewed all patients with biliary strictures who underwent endoscopic placement of a single biliary plastic stent from January 2006 to October 2017.

RESULTS

Two hundred forty-eight patients with 402 endoscopic retrograde cholangiopancreatography procedures were included. The incidence of distal migration was 6.2%. The frequency of duodenal injury was 2.2% in all cases and 36% in cases with distal migration. Benign biliary strictures (BBS), length of the stent above the proximal end of the stricture (> 2 cm), and duration of stent retention (< 3 months) were independently associated with distal migration (p = 0.018, p = 0.009, and p = 0.016, respectively). Duodenal injury occurred more commonly in cases with larger angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body (p = 0.018) or in cases with stent retention < 3 months (p = 0.031).

CONCLUSIONS

The risk factors of distal migration are BBS and the length of the stent above the proximal end of the stricture. The risk factor of duodenal injury due to distal migration is large angle (≥ 30°) between the distal end of the stent and the centerline of the patient's body. Distal migration and related duodenal injury are more likely to present during the early period after biliary stenting.

Size does matter: when a large plastic biliary stent ends up in the root of the mesentery

Duodenal perforations due to biliary stenting migration, although rare, can occur. We report a unique case of duodenal perforation due to a large in length plastic stent with no (or marginal) migration, which ended up in the root of the mesentery, explaining the normal laboratory values and minimal imaging findings observed. Any clinical symptom during the postprocedural period should raise the suspicion of a major complication and prompt quick management decisions.

Primary Endoscopic Closure of Duodenal Perforation Secondary to Biliary Stent Migration: A Case Report and Review of the Literature

Duodenal perforation due to biliary stent migration is rare, and it often requires surgical repair; however, endoscopic closure has recently become a viable option in the appropriate patients. We present the case of a 79-year-old female who underwent biliary stent placement for a common bile duct stricture, who subsequently was found to have a duodenal wall perforation secondary to stent migration. The stent was extracted endoscopically with successful defect closure using a ConMed^® repositional DuraClip™. We aim to contribute to the limited body of literature that describes endoscopic repair of duodenal perforation secondary to biliary stent migration using through-the-scope endoclips.

Percutaneous transhepatic techniques for retrieving fractured and intrahepatically dislodged percutaneous transhepatic biliary drainage catheters

Dislodged intrabiliary drainage devices, including catheters, endoprostheses, and stents, may further impair drainage and cause various local reactions, vascular and gastrointestinal tract complications. Endoscopic approaches for management of plastic biliary endoprostheses have been extensively discussed. However, in rare cases of fracture of percutaneous transhepatic biliary drainage (PTBD) catheters, only a percutaneous transhepatic technique for retrieving should be applied to avoid further damage by its rigid fragment. We present the adjusted techniques using either a goose neck snare, over-the-wire balloon catheter, or biopsy forceps with image demonstration and reviews. We encountered two patients with PTBD tube fracture and intrahepatic dislodgment. In both patients, percutaneous approaches were used for successfully retrieving and removing the fractured catheter through transhepatic tract: one with the use of a biopsy forceps, another with an inflatable balloon catheter.

Dislodged biliary stent causes lower gastrointestinal hemorrhage four years postendoscopic retrograde cholangiopancreatography

Endoscopic biliary stent placement is an efficient method for the decompression of the biliary system in various benign and malignant causes. Dislocation and stent migration is a well-known complication, with most displaced stents passing through the bowel, uneventfully. Rarely, migrated stents can be accounted for potentially life-threatening complications.

Retroperitoneal Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent into Periampullary Diverticula

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.

A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent

Background

Stent insertion is widely performed to restore biliary drainage in hepatic, biliary, and pancreatic obstructive conditions. Intestinal perforation due to the migration of these stents is an extremely rare late-term complication that is associated with a high rate of mortality. The current report aimed at presenting the radiological findings of a case of extraluminal biliary stent migration into the pelvic region that caused intestinal perforation.

Case Report

We report a case of an 85-year-old male with a history of previous stent insertion who presented with a sudden – onset severe abdominal pain. An abdominal multidetector computed tomography (MDCT) revealed a tubular foreign body density, compatible with intestinal perforation due to migration of the biliary stent.

Conclusions

Biliary stent insertion becomes a more common procedure. This serious complication must always be remembered in patients presenting with abdominal pain after stent insertion.

Biliary stent migration: a brief review of potential complications and possible etiological factors

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.

Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess

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.

Endoscopic extraction of proximally migrated biliary stent by intrastent balloon inflation

Endoscopically placed bile duct stents are commonly used to relieve obstruction in patients with benign or malignant biliary disease. These stents may become dislodged and migrate in about 5-10% of patients. Distally migrated stents can be managed expectantly, allowing the foreign body to pass through the rectum. However, proximal migration of biliary stents usually necessitates endoscopic stent removal. We present a case of a proximally migrated stent that was extracted successfully with intrastent balloon inflation during endoscopic retrograde cholangiopancreatography (ERCP).

Migrated biliary plastic stent causing double sigmoid colon perforation

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.

Imaging of abdominal and pelvic surgical and postprocedural foreign bodies

Every form of medical and surgical treatment, even the most trivial one, carries with it some chance of complications. This risk is usually small, and the benefit of the treatment should clearly outweigh the risk. Treatment-related complications may occur, however, presenting either soon after the intervention or remote from it. In this review, the focus is on imaging findings of surgical materials used in abdominal surgery, and of a wide array of implanted abdominal devices. The pertinent complications of these devices and of retained surgical objects are highlighted and illustrated.

Successful management of colonic perforation with a covered metal stent

Self-expandable stents are widely available for the treatment of perforation of the gastrointestinal tract. Because of the risk of migration, there has been no report of the use of self-expandable stents for the treatment of perforation of the colon or rectum. This is a report of successful treatment of iatrogenic colonic perforation during balloon dilatation of anastomotic stricture with a fully covered stent. Fully covered, self-expandable metallic stents can be considered useful tools for management of this condition.

Biliary stent migration causing perforation of the caecum and chronic abdominal pain

We report a case of biliary stent migration causing perforation of the caecum and presenting as chronic abdominal pain. The case was managed by colonoscopic removal of the stent.

Duodenal perforation secondary to migration of endobiliary prosthesis

A 27-year-old woman presented to the emergency department with abdominal pain, four days post endoscopic retrograde cholangiopancreatography (ERCP) and insertion of an endobiliary stent. A plain abdominal film highlighted the stent in an atypical position within the abdomen. As such, the patient progressed to a CT scan, confirming a retroperitoneal perforation of the duodenum by the stent. Laparotomy returned the stent to the duodenum with a primary duodenal repair. This case highlights the high index of suspicion required in patients who present with acute abdominal pain post-ERCP.

Double Sigmoid colon perforation due to migration of a biliary stent

Migration of pancreatico-biliary stents is a rare event, usually benign, but which can lead to severe complications such as digestive tube perforation. We report the case of a patient with double sigmoid perforation due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.

Surgical relief of small bowel obstruction by migrated biliary stent: extraction without enterotomy

Small bowel obstruction caused by biliary stent migration may be managed without enterotomy by using a combination of laparoscopy, endoscopy, and fluoroscopy.

Background:

Distal stent migration is a well-known complication following insertion of biliary stents. Most such cases can be managed expectantly, because the stents pass through the gastrointestinal tract. However, small bowel obstruction as a result of the stent mandates surgical intervention.

Methods:

We report the case of a patient who had distal stent migration causing a small bowel obstruction. We successfully retrieved the stent without an enterotomy, by using a combination of laparoscopy, endoscopy, and fluoroscopy. Our unique technique greatly decreased the risk of bacterial peritonitis in this patient with decompensated cirrhosis and associated ascites, which in this patient population results in a high mortality.

Results:

Management of small bowel obstruction secondary to biliary stent migration necessitates operative intervention. Retrieval of a dislodged stent can be performed safely without subjecting the patient to an enterotomy or a small bowel resection. Postoperative morbidity should be significantly reduced by this approach.

Conclusion:

Retrieval of biliary stents in cases of small bowel obstruction without perforation may be successfully performed without enterotomy or bowel resection. A similar approach may be applied to other foreign bodies dislodged in the small bowel.

Foreign objects encountered in the abdominal cavity at CT

Foreign objects are not infrequently seen at computed tomography (CT) of the abdomen and pelvis and may pose a diagnostic challenge to the radiologist, who must recognize the object, characterize its nature and location, and determine its clinical significance. Most foreign objects are incidentally detected at CT, but they may mimic a wide range of pathologic conditions. Some foreign objects (eg, an object that has been swallowed either intentionally or unintentionally) are the cause of the patient's signs and symptoms and require prompt medical attention. Other objects, such as a sponge or surgical instrument that has been retained postoperatively, may have medicolegal consequences. Furthermore, certain objects, such as intentionally concealed drug packets, may go undetected unless a high degree of suspicion exists and appropriate window settings are used to review the study. The radiologist should be familiar with the wide range of foreign objects that may be encountered at abdominopelvic CT, be able to recognize them promptly, and understand their implications for patient treatment.

An unusual digestive foreign body

Foreign digestive bodies present unusual circumstances because they are associated with various degrees of local trauma and may lead to direct perforation or delayed local injury. Patients with foreign bodies should be evaluated upon admission for signs of impaction and perforation. While all objects impacted in the esophagus require urgent treatment, rectal foreign bodies are usually removable through the anus. The current case illustrates successful endoscopic retrieval of a proximally located foreign body in a particular legal situation where physicians had to work closely with police officers and court members.

Perforation and abscess formation after radiological placement of a retrievable plastic biliary stent

Introduction

Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.

Case presentation

A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.

Conclusion

Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.

A review of problems following insertion of biliary stents illustrated by an unusual complication

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.

Colonic perforation secondary to migrated biliary stent. Case report of an unusual complication, and literature review

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.

Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers

BACKGROUND

Proximal or distal migration of a plastic biliary stent is uncommon, but its management can be a technical challenge to the pancreatobiliary endoscopist.

PATIENTS AND METHODS

All cases (n=51) of proximally and distally migrated plastic biliary stents over an 8-year period at 3 referral pancreaticobiliary centers were included in this retrospective study. Indications for stenting, risk factors for migration, presentation of migration, and various techniques used for stent's retrieval are herein analyzed.

RESULTS

Twenty-one proximal and 30 distal bile duct-migrated stents were identified. All patients with proximally and 17 (56.7%) with distally migrated stents were symptomatic. Choledocholithiasis, dilated common bile duct, short and large size stent were the main risk factors. The retrieval of proximally migrated stents was successful in 15 patients (71.4%) and in all symptomatic patients with distal migration. The retrieval techniques included forceps, Dormia basket, snare, Soehendra stent retriever, and balloon. One patient died of sepsis due to peritonitis from duodenal perforation from a distally migrated stent.

CONCLUSIONS

Retrieval of a proximally migrated stent requires experience with different endoscopic devices. Moreover, distal migration needs attention because it can cause severe complications.

An unusual cause of ileal perforation: Report of a case and literature review

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.