Abstract
A 69-year-old female with pancreatic head malignancy with obstructive jaundice and
duodenal bulb infiltration underwent endoscopic ultrasound (EUS)-guided hepaticogastrostomy
(HGS). During stent placement, proximal end of the metal stent got maldeployed inside
the peritoneal cavity along with loss of guidewire access. Multiple attempts to cannulate
the proximal end of stent through the puncture site were unsuccessful. Considering
the morbid nature of potential surgical option, a novel EUS-guided rescue technique
was performed. Body of previously maldeployed stent was identified with EUS examination
and was punctured with 19 G needle (transgastric route) followed by guidewire negotiation
in common hepatic duct. Sequential dilatation of gastric puncture site and stent was
performed. A fully covered self-expandable metallic stent was placed with the distal
end in previously maldeployed stent and the proximal end inside gastric lumen and
free flow of bile could be established. The present case highlights that stent maldeployment
can be a serious complication during EUS-HGS, which can occur even in expert hands.
Loss of proximal end in the peritoneal cavity may lead to a challenging situation,
which may be rescued by puncture of the maldeployed stent with the placement of additional
stent.
Keywords
EUS - hepaticogastrostomy - maldeployed stent
