Endoscopy 2013; 45(S 02): E301-E302
DOI: 10.1055/s-0033-1344413
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula

G. Mavrogenis
1  Department of Gastroenterology, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
,
M. Lalot
2  Department of Anesthesiology, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
,
Y. Hoebeke
3  Department of General Surgery, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
,
P. Warzée
1  Department of Gastroenterology, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
,
P. Van Ende
2  Department of Anesthesiology, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
,
A. Sibille
1  Department of Gastroenterology, Site Notre Dame, Grand Hôpital de Charleroi, Charleroi, Belgium
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Publikationsverlauf

Publikationsdatum:
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.

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Fig. 1 The patient was admitted for management of a recurrent pilonidal abscess. a Excision of the pilonidal abscess revealed a fistulous track (arrowhead). b A 10 Fr × 10 cm plastic biliary stent was retrieved from the fistula.
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Fig. 2 Postoperative computed tomography scan disclosed a 1-cm bone defect of the sacrococcygeal junction (arrowhead) in contact with the posterior wall of the rectum. The asterisk indicates the site of excision of the abscess.

Complications of stent placement are well known and include migration with fistula formation between a variety of organs, such as: duodenocolic fistula [1], duodenoscrotal fistula [2], enterosplenic fistula [3], enterocutaneous fistula [4], and colovaginal fistula [5]. However, to the best of our knowledge recurrent abscess secondary to a rectocutaneous fistula has not been described previously.

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