The pierced colon – when biliary stents go the wrong way

Aims Bowel perforation of straight biliary stents is a rare complication of biliary stenting. While duodenal perforation opposite to the papilla is not uncommon, colonic perforation, mainly in the sigmoid colon, is a rare complication. Colonic perforation outside anatomically predisposed sites has not been reported to date.

Methods We report the successful endoscopic treatment of a 78-year old male with a straight biliary plastic stent perforating the ascending colon without underlying structural abnormality in the affected segment. Perforation was detected incidentally during CT, the patient had been under continued antibiotic therapy for liver abscess. Stent extraction was performed by endoscopic snare; the site of perforation was closed with through- the- scope clips. The patient remained asymptomatic [1] [2] [3] [4] [5].

Results We reviewed the relevant literature on bowel perforations due to migrated biliary stents. Straight plastic stents caused 25 of 32 reported colonic perforations, while only one perforation was related to a pigtail stent, 5 cases did not state the involved stent type. Straight plastic stents appear to entail a higher risk of colonic perforation. Most cases were managed surgically (20/32), endoscopic therapy was performed in 10/32 cases; two stents were removed through a colocutaneous fistula. One patient had a colonic perforation after stent removal and required surgery. Mortality is low (1/32).

Conclusions Our case highlights colonic perforation as a serious, but fortunately very rare complication of biliary stenting.

Conflicts of interest

Authors do not have any conflict of interest to disclose.

• 1 Katsinelos P, Kountouras J, Paroutoglou G. et al. Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech 2009; 19: 217-221
• 2 Taj MA, Ghazanfar S, Qureshi S. et al. Plastic stent migration in ERCP; a tertiary care experience. J Pak Med Assoc 2019; 69: 1099-1102
• 3 Paspatis GA, Papastergiou V, Mpitouli A. et al. Distal Biliary Stent Migration in Patients with Irretrievable Bile Duct Stones: Long-Term Comparison Between Straight and Double-Pigtail Stents. Dig Dis Sci 2022; 67: 4557-4564
• 4 Emara MH, Ahmed MH, Mohammed AS. et al. Biliary stent migration: why, how, and what?. Eur J Gastroenterol Hepatol 2021; 33: 967-973
• 5 Arhan M, Odemiş B, Parlak E. et al. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc 2009; 23: 769-775

Publication History

Article published online:
14 April 2023