Small Bowel Perforation at the Duodeno-Jejunal Junction from a Migrated Biliary Stent: A Case Report

Abstract

Background: The most common sites of reported bowel perforation secondary to migrated biliary stents were duodenal or colonic. However, small bowel perforations were reported in a few cases. Herein we present a case of small bowel perforation secondary to migrated biliary plastic stent at the duodeno-jejunal junction (DJ). We think this peculiar site is the first to be reported as a perforation site secondary to migrated biliary stent. Case Presentation: We present the case of female Egyptian patient with severe abdominal pain and air under diaphragm after Endoscopic Retrograde Cholangiopancreatography (ERCP) for Klatskin tumor. The patient underwent a midline laparotomy. A moderate collection of enteric fluid was encountered with migrated stent causing perforation of the small intestine at DJ. The stent was removed, and primary closure was done. The patient could not be extubated due to bad chest condition and admitted to ICU for 48 hours then extubated after improvement of the chest condition and ability of the patient to maintain good oxygen saturation in room air. Unfortunately, the patient developed massive pulmonary embolism on the fifth postoperative day and died. Conclusion: Suspicion of stent migration should be put in mind in any patient presented with abdominal pain with history of previous ERCP and biliary stenting. Endoscopic removal and mucosal repair are possible in select cases. This is still not available for DJ or small bowel. Further research and future innovations may overcome this challenge.