Percutaneous retrieval of a biliary stent after migration and ileal perforation

Derek M Culnan,Robert A Cherry,Bryan J Cicuto,Harjit Singh

doi:10.1186/1749-7922-4-6

Abstract

We present a case of a migrated biliary stent that resulted in a distal small bowel perforation, abscess formation and high grade partial small bowel obstruction in a medically stable patient without signs of sepsis or diffuse peritonitis. We performed a percutaneous drainage of the abscess followed by percutaneous retrieval of the stent. The entero-peritoneal fistula closed spontaneously with a drain in place. We conclude, migrated biliary stents associated with perforation distal to the Ligament of Trietz (LOT), may be treated by percutaneous drainage of the abscess and retrieval of the stent from the peritoneal cavity, even when associated with a large intra-abdominal abscess.

Highlights

A 76-year-old woman was admitted with cholecystitis and choledocholithiasis diagnosed via computed tomographic (CT) scan
We present an unusual case of biliary stent migration with distal small bowel perforation and abscess formation which was successfully treated using interventional radiology techniques, including percutaneous drainage and fluoroscopic removal of the stent
CFiTguSrcean2of the common bile duct stent CT Scan of the common bile duct stent. 3-Dimensional reconstruction of CT data demonstrating the migrated biliary stent to be extraluminal in the left lower quadrant

Summary

Introduction

A 76-year-old woman was admitted with cholecystitis and choledocholithiasis diagnosed via computed tomographic (CT) scan. A CT scan was performed which demonstrated a 5.8 × 6.2 cm abscess within the right lower quadrant with an extraluminal, radiodense biliary stent within the abscess cavity (Figure 1). A transition point of dilated small bowel was located adjacent to the abscess cavity The patient missed her appointment to have the stent removed due to medical illness and was lost to follow-up by the endoscopist. Given her multiple comorbid conditions, hemodynamic stability, as well as the patient's strong desire to attempt non-operative management, the decision was made to immediately perform CT guided aspiration of the abscess with drain placement.

Findings

Discussion

Conclusion