Endoscopic internal biliary drainage is known to provide effective palliative decompression
therapy for malignant and benign biliary obstructions [1]
[2]. Late complications developing after the insertion of endoprostheses include stent
clogging (33 %), cholangitis (15 %), stent migration into the bile duct (3 %), stent
migration into the gastrointestinal tract (3 %), fracture of the endoprosthesis (1
%), and perforation (1 %) [2].
A 59-year-old man with a previously diagnosed benign biliary stricture was admitted
with symptoms of fever, jaundice, and epigastric pain. His history included endoscopic
insertion of a 10-Fr plastic stent into the common bile duct 5 years previously. Duodenoscopy
revealed a swollen papilla and another orifice in addition to the original one near
to the papilla. The tip of the stent was emerging from this second orifice. When an
endoscopic retrograde cholangiopancreatography (ERCP) cannula was inserted through
the original orifice, it emerged into the duodenum from the second orifice. The stent
had apparently dislocated into the common bile duct and then perforated the common
bile duct through the duodenum to form the second orifice (Figure [1]). We concluded that this new orifice was actually a fistula. When the stent was
removed, a large impacted stone was found at its intrabiliary end (Figure [2]).
Figure 1 An endoscopic retrograde cholangiopancreatography (ERCP) cannula was inserted into
the original orifice and emerged near to the stent
Figure 2 The impacted stone found at the intrabiliary tip of the stent
The simultaneous occurrence of a stone and a fistula may have been caused by the presence
of the endoprosthesis for a prolonged period [2]. In summary, this case showed impaction of a stone at the distal end of a long-term
plastic stent, resulting in fistula formation and displacement of the distal end of
the stent into the duodenum through the fistula.
