Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula
05 September 2013 (online)
A 53-year-old patient was admitted to the gastroenterology department for the management of a benign biliary stricture secondary to chronic alcoholic pancreatitis. He underwent sphincterotomy and placement of a 10 Fr × 10 cm plastic biliary stent. Endoscopic follow-up 2 months later revealed spontaneous migration of the stent and no further intervention was performed.
The patient was admitted to the general surgery outpatient clinic 7 years later for the management of a recurrent pilonidal abscess. Excision of the abscess revealed a long fistulous track towards the coccyx with a plastic stent inside it ([Fig. 1 a, b]); the findings indicated a rectocutaneous fistula secondary to biliary stent migration. In addition, computed tomography scan showed a 1-cm defect of the sacro-coccygeal junction in contact with the rectum ([Fig. 2]). Postoperatively, the patient was treated with antibiotics and vacuum-assisted closure therapy and went on to make an excellent recovery. His follow-up over 4 years was unremarkable.
Complications of stent placement are well known and include migration with fistula formation between a variety of organs, such as: duodenocolic fistula , duodenoscrotal fistula , enterosplenic fistula , enterocutaneous fistula , and colovaginal fistula . However, to the best of our knowledge recurrent abscess secondary to a rectocutaneous fistula has not been described previously.
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