S3460 A Case of Forgotten Biliary Stent Presenting as Multiple Liver Lesions: A Single Institution Experience

Abstract

Introduction: Placement of a biliary stent is essential in certain biliary pathologies for prevention of cholangitis. The major disadvantage of biliary stenting is clogging of the endoprosthesis. We present a case of hepatic abscesses in a non-compliant patient with history of biliary stents. Case Description/Methods: 37 year old white female with no past medical history was admitted for abdominal pain since past four days. Patient complained of right upper quadrant pain, radiating to the back associated with fever, fatigue, loss of appetite and diarrhea. Review of system was negative for weight loss, travel, drug use. Surgical history was significant for cholecystectomy with intraoperative cholangiography for choledocholithiasis followed by stent placement ten years ago. Family and social history were insignificant. Patient had right upper quadrant tenderness on palpation but rest of the physical exam was not significant. Laboratory findings were significant for leukocytosis with left shift. On CT imaging multiple hypodense masses in the dome of the liver with intrahepatic biliary ductal dilatation and two biliary stents. On endoscopic retrograde cholangiopancreatography the common bile duct appeared dilated with radiolucent filling of innumerable scattered lesions liver. Old stents were removed followed by drainage of pus, stone extractions and new stent placement with successful drainage of bile. Patient recovered well after the procedure and was discharged on antibiotics. On follow up imaging study, previously seen multiple hepatic lesions were not noted. The follow up cholangiopancreatography, previously noted innumerable hepatic lesions had resolved Discussion: Biliary stent placement is important in maintaining bile flow in cases of choledocholithiasis with cholangitis. Replacement of plastic stents is therefore recommended every 3-6 months to prevent stent related complications. Long-standing biliary stents increase the risk of cholangitis due to formation of biliary stones, as the biliary stent itself may serve as a nidus for stone formation. The rate of complications, such as cholangitis or stent impaction, might be increased as the stent was in place for a longer duration, and CBD stone development ultimately occurred in most cases of long-standing biliary stent. All patients should be informed of the possibility of complications related to retained long-term endoprosthesis placement, and stent change or definite treatment should be considered within 1 year of stent placement.Figure 1.: PRE and POST Imaging after stent removal.