Endoscopic Retrieval of an Upstream-Migrated Pancreatic Stent: A Case Report

Abstract

A 48 year-old woman received laparoscopic cholecystectomy due to acute cholecystitis. Biliary pancreatitis developed 7 days after the surgery and endoscopic retrograde cholangiopancreatography was conducted to clear the bile duct. However, repeated cannulation of the pancreatic duct was encountered and a 3 French, 3/4 pigtail pancreatic stent (6 cm) was inserted to avoid worsening pancreatitis. Such stent is expected to pass into intestine spontaneously in 30 days and another endoscopy to retrieve it is usually not necessary. However, the pancreatic stent migrated to the upstream with total embedding after resolution of the pancreatitis. Endoscopic retrieval was conducted with withdrawing a deep-threaded retrieval balloon and the pancreatic stent was successfully extracted. Such a case is rare, and surgical retrieval of the stent carries high complication rate. To achieve successful endoscopic retrieval, skillful endoscopist and full-equipped facility are needed. With the progression of pancreatic therapy, pancreatic stent implantation is expected to be increased and clinicians might face more complications of that. Thus we suggest careful manipulation to insert a prophylactic pancreatic stent in optimal depth and length, following up position of the stent after procedure and preparing equipments for rescue once upstream migration of a pancreatic stent happens.