Perforation Due to Biliary Stent: Case Report and Review

Flavio Tirelli; Paolo Mirco; Pietro Fransvea; Gilda Pepe; Andrea Tringali; Marta di Grezia; Claudio Lodoli; Valerio Cozza; Antonio La Greca; Gabriele Sganga

doi:10.1055/s-0041-1733777

Digestive Disease Interventions, Table of Contents

Digestive Disease Interventions 2021; 05(04): 324-330
DOI: 10.1055/s-0041-1733777

Case Report

Perforation Due to Biliary Stent: Case Report and Review

Flavio Tirelli

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Paolo Mirco

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Pietro Fransvea

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Gilda Pepe

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Andrea Tringali

²Department of Surgical Sciences, Surgical Endoscopy Unit, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Marta di Grezia

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Claudio Lodoli

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Valerio Cozza

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Antonio La Greca

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

,

Gabriele Sganga

¹Emergency and Trauma Surgery, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy

› Author Affiliations

Abstract

Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.

Keywords

biliary stents - migration - duodenal perforation - biliary peritonitis - ERCP

Full Text

References

References
1 Freeman ML. Adverse outcomes of endoscopic retrograde cholangiopancreatography: avoidance and management. Gastrointest Endosc Clin N Am 2003; 13 (04) 775-798 , xi
2 Christensen M, Matzen P, Schulze S, Rosenberg J. Complications of ERCP: a prospective study. Gastrointest Endosc 2004; 60 (05) 721-731
3 Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992; 38 (03) 341-346
4 Saranga Bharathi R, Rao P, Ghosh K. Iatrogenic duodenal perforations caused by endoscopic biliary stenting and stent migration: an update. Endoscopy 2006; 38 (12) 1271-1274
5 Aliperti G. Complications related to diagnostic and therapeutic endoscopic retrograde cholangiopancreatography. Gastrointest Endosc Clin N Am 1996; 6 (02) 379-407
6 Gui D, Pepe G, Callari C, Persiani R, Di Giorgio A, Magalini S. Vacuum-assisted wound care (V.A.C.®) for enteric fistula closure: how we do it. World J Surg 2014; 38 (12) 3280-3283
7 Magalini S, Pepe G, Cozza V. et al. Negative pressure wound therapy (NPWT) in duodenal breakdown fistulas: negative pressure fistula therapy (NPFT)?. Eur Rev Med Pharmacol Sci 2017; 21 (10) 2452-2457
8 Vezakis A, Fragulidis G, Polydorou A. Endoscopic retrograde cholangiopancreatography-related perforations: diagnosis and management. World J Gastrointest Endosc 2015; 7 (14) 1135-1141
9 Namdar T, Raffel AM, Topp SA. et al. Complications and treatment of migrated biliary endoprostheses: a review of the literature. World J Gastroenterol 2007; 13 (40) 5397-5399
10 Stapfer M, Selby RR, Stain SC. et al. Management of duodenal perforation after endoscopic retrograde cholangiopancreatography and sphincterotomy. Ann Surg 2000; 232 (02) 191-198
11 O'Connor R, Agrawal S, Aoun E, Kulkarni A. Biliary stent migration presenting with leg pain. BMJ Case Rep 2012; 2012: bcr-2012-007588
12 Bharathi RS, Rao PP, Ghosh K. Intra-peritoneal duodenal perforation caused by delayed migration of endobiliary stent: a case report. Int J Surg 2008; 6 (06) 478-480
13 Paspatis GA, Dumonceau JM, Barthet M. et al. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy 2014; 46 (08) 693-711
14 Kim KW. A primary repair with hemoclips and fibrin glue injection in biliary stent induced duodenal perforation. Korean J Gastrointest Endosc 2011; 42: 437
15 Knudson K, Raeburn CD, McIntyre Jr RC. et al. Management of duodenal and pancreaticobiliary perforations associated with periampullary endoscopic procedures. Am J Surg 2008; 196 (06) 975-981 , discussion 981–982