Abstract
IntroductionRetrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.Case presentationA 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.ConclusionLate retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
Highlights
Retrievable plastic biliary stents are usually inserted endoscopically
Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management
We report a case of delayed perforation and abscess formation after radiological insertion of a plastic stent
Summary
Complications after endoscopic insertion of retrievable plastic biliary stents are well recognised, including perforation of the duodenum, small bowel and large bowel after migration of the stent [1,2,3,4]. The position of the stents appeared satisfactory (Figure 3), and cholangiography confirmed good drainage. Abdominal CT was performed the day, which revealed a large gas-containing collection in the retroperitoneum, with evidence of migration of one of the plastic stents, which appeared to have eroded. The second stent was in a satisfactory position, allowing biliary drainage. The migrated stent was snared under fluoroscopic guidance, and a 12F pigtail drain was inserted into the collection. Six days after the drainage procedure he reported pain around the site of the drain. The collections identified previously below the level of the duodenum and in the right retroperitoneal region had almost completely resolved
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