Perforation Due to Biliary Stent: Case Report and Review

Abstract

Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.

Keywords

biliary stents - migration - duodenal perforation - biliary peritonitis - ERCP

Authors' Contributions

All the authors agreed on the final version of the manuscript and are accountable in all aspects of the work for ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

P.M., P.F., F.T.: Study conception and design, literature search, acquisition, interpretation, and analysis of data; drafting and critically revising the article for important intellectual content; and final approval of the version to be published. A.L.G.: Critical revision of the article for important intellectual content; and final approval of the version to be published. M.d.G., G.P., C.L.: Interpretation and analysis of data. A.T., G.S.: Critical revision of the article for important intellectual content and final approval of the version to be published.

Publikationsverlauf

Eingereicht: 23. Februar 2021

Angenommen: 24. Juni 2021

Artikel online veröffentlicht:
23. August 2021

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