Appendiceal perforation due to biliary stent migration in a neutropenic patient with lung cancer receiving chemotherapy: A case report

Bowel Perforation Caused by Biliary Stent Migration After ERCP: A Systematic Review

GOALS

This systematic review aims to evaluate the risk factors, clinical features, and outcomes of bowel perforation caused by stent migration after endoscopic retrograde cholangiopancreatography (ERCP).

BACKGROUND

Distal migration of biliary stents can occur after ERCP. Upon migration, most stents pass through the intestine without adverse events; however, bowel perforation has been reported.

STUDY

A comprehensive literature search of PubMed, EMBASE, and Cochrane databases was conducted through October 2023 for articles that reported bowel perforation because of stent migration. Cases of incomplete stent migration and proximal stent migration were excluded. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to identify full-length articles in English reporting.

RESULTS

Of 2041 articles retrieved on the initial search, 92 met the inclusion criteria. A total of 132 cases of bowel perforation occurred due to stent migration after ERCP (56.1% female; average age: 66 y). The median time from initial ERCP to perforation was 44.5 days (IQR 12.5-125.5). Most cases of perforation occurred in the small bowel (64.4%) compared with the colon (34.8%). Stents were mostly plastic (87.1%) with a median diameter of 10 Fr (IQR 8.5-10) and median length of 10.3 cm (IQR 715). Surgical management was pursued in 52.3% and endoscopic management in 42.4%. Bowel resection was required for 25.8% of patients. The overall mortality rate was 17.4%.

CONCLUSION

In summary, this study demonstrates that bowel perforation after ERCP stent migration primarily occurs within 44.5 days and most frequently with a 10 Fr plastic biliary stent. The overall mortality rate was 17.4%. It is important for endoscopists to be mindful of this rare but serious adverse event.

Conservative Treatment of Sigmoid Diverticulum Perforation Secondary to Migrated Biliary Plastic Prostheses Inserted by Endoscopic Retrograde Cholangiopancreatography: A Case Report of an Unusual Adverse Event and Literature Review

Distal migration of biliary plastic stents is rare. Although these stents are primarily used in the treatment of benign diseases of the biliopancreatic tract, their distal migration can lead to severe complications, such as perforation of any part of the digestive system. The authors report a case of sigmoid diverticulum perforation caused by the migration of a biliary plastic stent, which had been initially placed due to a failure to extract a common bile duct (CBD) stone. A review of similar cases in the literature was conducted, and the findings were analyzed in relation to the reported case. The search was performed in MEDLINE and the Cochrane Library, covering studies published between 1975 and 2025. Only studies describing the placement of biliary plastic stents during endoscopic retrograde cholangiopancreatography (ERCP) were included, while studies with incomplete data were excluded. This study highlights this rare and serious complication, which carries a high morbidity rate. Despite careful stent positioning during ERCP and periodic follow-up, this adverse event (AE) cannot always be prevented. Although distal stent migration with perforation can often be treated endoscopically, preoperative evaluation of the patient's clinical condition and precise localization of the perforation is crucial for successful endoscopic stent removal, thus avoiding the need for surgery.

Duodenum and ascending colonal perforation due to biliary stent migration

Introduction

Bowel perforation due to migrated biliary stent is a rare complication. Here, we report a case of duodenal and ascending colonal perforation due to biliary stent migration.

Case presentation

A 35-year-old man is complaining of right upper abdominal pain presented to the gastroenterology department. Two months ago, he was diagnosed with common bile duct stone with acute cholangitis, a straight plastic biliary stent was placed in his common bile duct. Abdominal computed tomography, upper endoscopy and colonoscopy confirmed that the stent penetrated the duodenum into the ascending colon. The stent was extracted by upper endoscopy, and the defects of the duodenum and ascending colon were closed by clips endoscopically.

Discussion

Bowel perforation due to biliary stent migration is a rare but severe complication. Risk factors for dislocation of stents include stent insertion for more than one month, wide stent, benigh diseases and longer stent. Endoscopy is a minimally invasive and safe meneuver to retrieve stent.

Conclusion

Patients inserted with long, wide and straight biliary stent for more than one month are at high risk of stent dislocation. Endoscopy is a minimally invasive and safe meneuver to retrieve stent, and should be considered as the first-line treatment.

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.

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.