A 73-year-old man was admitted with sharp tenderness in the left iliac fossa, peritonitis,
fever, and leukocytosis. The patient had undergone an endoscopic retrograde cholangiography
15 days earlier, which showed choledocholithiasis and benign biliary stricture. The
stones were extracted and a 10-Fr, 12-cm plastic biliary stent was inserted. A computed
tomography (CT) scan revealed that the biliary stent had migrated and caused sigmoid
colon perforation with mild pneumoperitoneum ([Fig. 1]). Sigmoidoscopy was carried out after colon preparation with enema. It showed extensive
diverticulosis in the sigmoid colon and the stent was 30 cm from the anus. Its tip
had perforated the wall of the sigmoid colon, near the diverticula ([Fig. 2]). The stent was atraumatically removed with foreign body forceps. A punctate perforation
([Fig. 3]) was closed with two through-the-scope clips and an endoloop ([Fig. 4]). Broad-spectrum antibiotics were commenced, but 5 days later, the patient developed
fever. A CT scan showed a 4-cm abscess in the pelvis. The antibiotics were continued
and after five days another follow-up CT scan showed no evidence of an abscess. The
patient was discharged 14 days after admission.
Fig. 1 Computed tomography (CT) scan in a 73-year-old man with sharp tenderness in the left
iliac fossa, peritonitis, fever, and leukocytosis following endoscopic retrograde
cholangiography. The scan shows a biliary stent perforating the sigmoid colon.
Fig. 2 Endoscopic image of the biliary stent embedded in the wall of the sigmoid colon.
Fig. 3 A small punctate perforation was seen after removal of the biliary stent.
Fig. 4 Completed closure was achieved with deployment of two clips and one endoloop.
There are few reported cases of clinically significant complications of spontaneous
migration of
biliary stents [1]. Most of these patients were treated surgically [2]. Patients with a history of diverticular disease are at higher risk of the stent
being hindered from going through the bowel lumen [3]. Only four cases of colon perforation by a plastic biliary stent which was removed
endoscopically [1]
[4]
[5] have been published to date. This is the first report of a patient in whom removal
of the biliary stent and closure of the perforation were carried out endoscopically.
Endoscopy_UCTN_Code_CPL_1AK_2AI
