Removal of an impacted migrated biliary stent with cholangioscopy: lights, camera, action.

Abstract

A 50-year-old woman was referred for removal of an internally migrated biliary stent. Fluoroscopy showed the migrated biliary stent and cholecystectomy clips ([Fig. 1]). She underwent endoscopic retrograde cholangiopancreatography (ERCP) and a biliary balloon was passed over the guidewire. Balloon sweeping was done; however, on sweeping, fresh blood was noticed emerging through the papilla. The procedure was therefore abandoned and a 7-Fr, 10-cm double-pigtail plastic stent (DPPS) was placed alongside the migrated stent. On day 3, the patient presented with severe anemia and hypotension. Contrast-enhanced computed tomography angiography (CTA) showed a right hepatic artery pseudoaneurysm, with an adjacent hematoma. She underwent conventional angiography and angioembolization with cyanoacrylate ([Fig. 2]).