Biliary stent migration with colonic diverticular impaction

Abstract

placed for duct decompression. The proximal tip of the stent was located within the left hepatic duct and its position confirmed. The patient was to return at a later date for a second attempt at stone extraction, but 4 days later she developed upper gastrointestinal bleeding. Upper gastrointestinal en­ doscopy demonstrated multiple erosions of the gastric an­ trum and body. Examination of the duodenum revealed no evidence of bleeding, but the biliary stent could not be located within the duodenal lumen. Plain abdominal x-ray identified the migrated stent in the left lower quadrant. Despite recommendations, the patient refused further inter­ vention and had an otherwise uneventful recuperation. Liver and pancreatic chemistries normalized prior to discharge, suggesting spontaneous stone passage. Thirteen months after her initial presentation, the patient returned to the clinic for an unrelated condition. Sponta­ neous rectal passage of the stent had not been observed. A plain abdominal film (Fig. 1) showed the stent, in an un­ changed location in the left lower quadrant in the area of the sigmoid colon. Sigmoidoscopy was performed and the stent was identified at approximately 60 cm from the anus. Its more proximal tip was embedded within a diverticulum, seemingly anchored by the flange. A small adherent blood clot was noted within the diverticular orifice although there had been no recent history of gastrointestinal bleeding or laboratory evidence to suggest a decrease in hemoglobin. Several other small diverticula were also noted in the sig­ moid colon. The stent was grasped with a rat-toothed forceps and atraumatically withdrawn. The patient had experienced no symptoms related to the stent in the sigmoid colon, and no complications were noted following its removal. Six months later, she has had no symptoms suggestive of pancreaticobiliary disease and serum chemistries remain normal.