Endoscopy 2013; 45(S 02): E324-E325
DOI: 10.1055/s-0033-1344773
Cases and Techniques Library (CTL)
© Georg Thieme Verlag KG Stuttgart · New York

Pancreatic stent migration into the bile duct causing cholangitis

J. A. Zapatier
Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States of America
,
P. Jani
Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States of America
,
R. Pimentel
Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States of America
,
T. Erim
Department of Gastroenterology and Hepatology, Cleveland Clinic Florida, Weston, Florida, United States of America
› Author Affiliations
Further Information

Corresponding author

T. Erim
Department of Gastroenterology and Hepatology
Cleveland Clinic Florida
2950 Cleveland Clinic Blvd.
Weston
Florida 33331
USA   
Fax: +1-954-6595647   

Publication History

Publication Date:
10 September 2013 (online)

 

A 71-year-old woman with history of surgical sphincteroplasty for a benign ampullary stricture presented with recurrent episodes of acute pancreatitis. An endoscopic retrograde cholangiopancreatography (ERCP) showed the common bile duct outlet separated from the ampulla, and distal stenosis of the ventral pancreatic duct. A pancreatic sphincterotomy was carried out, followed by the placement of a straight plastic 5-Fr × 3 cm stent into the pancreatic duct ([Fig. 1]). Post procedure computed tomography, carried out for abdominal pain, showed the pancreatic stent lying within the head of the pancreas ([Fig. 2 a]). An abdominal radiograph obtained 10 days later showed the stent in the area of the hepatic flexure, suggesting spontaneous distal migration ([Fig. 3]). After 2 months, the patient presented with cholangitis. Abdominal CT revealed a bright linear object extending from the common hepatic duct to the right intrahepatic biliary tree ([Fig. 2 b]). An ERCP was done and the 5-Fr × 3 cm plastic pancreatic duct stent was removed from the right intrahepatic biliary tree using a biliary extraction balloon catheter.

Zoom Image
Fig. 1 Endoscopic view of the second portion of the duodenum in a 71-year-old woman with history of surgical sphincteroplasty for a benign ampullary stricture and recurrent episodes of acute pancreatitis. The pancreatic duct stent sits in the pancreatic duct; the arrowhead indicates the location of the biliary opening.
Zoom Image
Fig. 2 a Computed tomography (CT) scan of the abdomen on the day of the procedure shows the pancreatic duct stent at the head of the pancreas. b After 2 months, the stent was seen within the right intrahepatic duct.
Zoom Image
Fig. 3 X-ray of the abdomen 10 days after pancreatic stent placement.

Distal spontaneous migration is common among 5-Fr × 3 cm pancreatic duct stents that do not have a flange on the pancreatic duct side; the migration rate is up to 96.7 % by day 3 [1]. Proximal migration occurs in up to 5 % of cases [2]. We present an unusual case of pancreatic stent migration where the stent migrated distally into the duodenum and then migrated into and far up the biliary tree, causing cholangitis. Surgical sphincteroplasty probably allowed entry of the straight stent into the biliary tree. We suggest the use of single-pigtail pancreatic duct stents in patients with altered ampullary anatomy to decrease the risk of such occurrences.

Endoscopy_UCTN_Code_CPL_1AK_2AD


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Competing interests: None


Corresponding author

T. Erim
Department of Gastroenterology and Hepatology
Cleveland Clinic Florida
2950 Cleveland Clinic Blvd.
Weston
Florida 33331
USA   
Fax: +1-954-6595647   


Zoom Image
Fig. 1 Endoscopic view of the second portion of the duodenum in a 71-year-old woman with history of surgical sphincteroplasty for a benign ampullary stricture and recurrent episodes of acute pancreatitis. The pancreatic duct stent sits in the pancreatic duct; the arrowhead indicates the location of the biliary opening.
Zoom Image
Fig. 2 a Computed tomography (CT) scan of the abdomen on the day of the procedure shows the pancreatic duct stent at the head of the pancreas. b After 2 months, the stent was seen within the right intrahepatic duct.
Zoom Image
Fig. 3 X-ray of the abdomen 10 days after pancreatic stent placement.