Plastic biliary stent migration as a cause of ascending colon perforation.

Abstract

A 65-year-old male with pancreatic cancer stage IV and history of endoscopic retrograde cholangiopancreatography (ERCP) and plastic biliary stent placement 43 days earlier, arrived to the emergency department with 8-hour right upper quadrant pain, fever, and shivering. Contrast enhanced computed tomography showed migration of the biliary stent to the ascending colon, with signs of perforation on its antimesenteric edge. A surgical approach by laparotomy was decided. The biliary stent was found perforating the ascending colon and in contact with the abdominal wall. The stent contained the colonic perforation, avoiding leakage. Removal of migrated endoprosthesis and primary closure was made. The patient remained in observation and with IV antibiotics, a new was performed ERCP with placement of an 8 cm by 10 Fr Amsterdam-type plastic stent on the 7th day due to cholangitis, with subsequent complete recovery. Endoscopic placement of stents has become a well-established procedure for biliary disease. Stent migration may be present in up to 6-8% of the cases. In most cases, distal migration has an uncomplicated passage, but it may cause bowel injury in up to 1%. This life-threatening complication requires prompt evaluation and management either by endoscopic or surgical approach.