Endoscopic transgastric extraction of a prophylactic pancreatic single-pigtail plastic stent that had previously migrated into the caudal part of the Wirsung duct.

Abstract

We present the case of a 50-year-old patient who had undergone a previous endoscopic ampullectomy. A 5-Fr single-pigtail plastic stent was inserted into the Wirsung duct in order to prevent postresection acute pancreatitis [1]. Unfortunately, the stent immediately migrated distally into the pancreatic duct, was impossible to extract on endoscopy, and later lead to severe necrotizing pancreatitis of the body and tail of the pancreas. The patient remained septic and the perisplenic necrotic cavities were filled with collected necrotic material ([Fig. 1]), so we performed endoscopic ultrasound (EUS)-guided drainage using a fully covered lumen-apposing metal stent (LAMS; Axios; Boston Scientific, USA) ([Fig. 2] and [Fig. 3 a]) [2]. Despite this leading to a rapid amelioration of the necrotizing pancreatitis, there remained the problem of the migrated intrapancreatic stent.