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Orsini-Ardengh A, Orsini-Arman AC, Haueisen Figueiredo Zwetkoff B, Micelli-Neto O, Surjan RCT, Ardengh JC. Conservative Treatment of Sigmoid Diverticulum Perforation Secondary to Migrated Biliary Plastic Prostheses Inserted by Endoscopic Retrograde Cholangiopancreatography: A Case Report of an Unusual Adverse Event and Literature Review. Cureus 2025; 17:e79042. [PMID: 40099079 PMCID: PMC11913399 DOI: 10.7759/cureus.79042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2025] [Indexed: 03/19/2025] Open
Abstract
Distal migration of biliary plastic stents is rare. Although these stents are primarily used in the treatment of benign diseases of the biliopancreatic tract, their distal migration can lead to severe complications, such as perforation of any part of the digestive system. The authors report a case of sigmoid diverticulum perforation caused by the migration of a biliary plastic stent, which had been initially placed due to a failure to extract a common bile duct (CBD) stone. A review of similar cases in the literature was conducted, and the findings were analyzed in relation to the reported case. The search was performed in MEDLINE and the Cochrane Library, covering studies published between 1975 and 2025. Only studies describing the placement of biliary plastic stents during endoscopic retrograde cholangiopancreatography (ERCP) were included, while studies with incomplete data were excluded. This study highlights this rare and serious complication, which carries a high morbidity rate. Despite careful stent positioning during ERCP and periodic follow-up, this adverse event (AE) cannot always be prevented. Although distal stent migration with perforation can often be treated endoscopically, preoperative evaluation of the patient's clinical condition and precise localization of the perforation is crucial for successful endoscopic stent removal, thus avoiding the need for surgery.
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Affiliation(s)
- André Orsini-Ardengh
- Gastrointestinal Endoscopy, Hospital Das Clínicas da Faculdade De Medicina da Universidade De São Paulo, São Paulo, BRA
| | | | | | | | - Rodrigo Cañada T Surjan
- Surgery, Faculdade De Medicina da Universidade De São Paulo, São Paulo, BRA
- Surgery, Hospital Nove De Julho, Diagnósticos da América S.A., São Paulo, BRA
| | - Jose C Ardengh
- Gastrointestinal Endoscopy, Hospital Das Clínicas De Ribeirão Preto, Ribeirão Preto, BRA
- Image Diagnosis, Universidade Federal De São Paulo, São Paulo, BRA
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AlZoubi L, Badwan B, Fayyad A. Ileal perforation due to migrated biliary stent: A case report. Arab J Gastroenterol 2023; 24:180-182. [PMID: 37673707 DOI: 10.1016/j.ajg.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
Ileal perforation caused by the migration of a biliary stent is a rare complication that can occur during endoscopic stent placement for benign or malignant biliary tract diseases. The current study reports the case of a 45-year-old woman with a history of Endoscopic retrograde cholangiopancreatography (ERCP) in which a migrated biliary stent resulted in an ileal perforation.
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Affiliation(s)
- Lujain AlZoubi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Basem Badwan
- General Surgery, Al-Basheer Hospital, Amman, Jordan
| | - Ahmad Fayyad
- General Surgery, Al-Basheer Hospital, Amman, Jordan
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Park TY, Hong SW, Oh HC, Do JH. Colonic diverticular perforation by a migrated biliary stent: A case report with literature review. Medicine (Baltimore) 2021; 100:e28392. [PMID: 34967373 PMCID: PMC8718208 DOI: 10.1097/md.0000000000028392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature. PATIENTS CONCERNS A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago. DIAGNOSES Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis. INTERVENTIONS Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed. OUTCOMES On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications. LESSONS Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.
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Affiliation(s)
- Tae Young Park
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sung Woo Hong
- Department of General Surgery, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Hyoung-Chul Oh
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae Hyuk Do
- Division of Gastroenterology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Tsang CLN, O'Neill RS, Joseph CM, Palasovski T. Small Bowel Perforation Secondary to Biliary Stent Migration in an Incarcerated Inguinal Hernia. Cureus 2020; 12:e7268. [PMID: 32292679 PMCID: PMC7153812 DOI: 10.7759/cureus.7268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We describe the case of a 90-year-old female who presented with signs of a strangulated inguinal hernia. Further history revealed a paired biliary-pancreatic stent insertion three years prior for ascending cholangitis and a long-standing asymptomatic right inguinal hernia. Biochemistry revealed a slightly elevated C-reactive protein level of 65 mmol/L, but was otherwise unremarkable. Abdominal CT demonstrated two plastic biliary stents within an incarcerated right inguinal hernia. At the time of surgery, a 3-mm perforation due to the stents was identified in the small bowel within the hernia. The stents were retrieved via an enterotomy that was subsequently repaired with full-thickness interrupted sutures. A tissue-suture repair of the inguinal hernia was performed due to significant contamination of enteric contents in the operative field. The patient had an unremarkable recovery and was discharged four days after her operation. This is a very rare acute presentation of stent migration with only a handful of such reported cases in the literature. With the rising number of endoscopic biliary stenting procedures, these complications are likely to increase, and clinicians need to be aware of this possibility in patients with pre-existing hernias.
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Siaperas P, Ioannidis A, Skarpas A, Angelopoulos A, Drikos I, Karanikas I. A rare cause for Hartmann's procedure due to biliary stent migration: A case report. Int J Surg Case Rep 2017; 31:83-85. [PMID: 28122319 PMCID: PMC5257179 DOI: 10.1016/j.ijscr.2017.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/08/2017] [Accepted: 01/08/2017] [Indexed: 12/12/2022] Open
Abstract
Migration of a biliary stent can cause life-threatening complications. When a stent migration occurs, in case of complications, surgical removal is the only treatment option. Among the complications associated with stent migration, intestinal bleeding, obstruction and perforation are of outmost importance. Introduction Biliary stent migration (proximal or distal) occurs in 6% of all cases. The majority of these migrating stents are passing through the intestine, without causing any complications. Usually when a stent migration occurs, endoscopic retrieval is the proper treatment option, except in case of complications when surgical removal is the only treatment option. This report presents a case of a biliary stent which migrated and caused a sigmoid colon perforation. Presentation of case A 75 years old female patient presented to the emergency department with diffuse abdominal pain, nausea and vomiting. Clinical examination showed distended abdomen and signs of peritoneal irritation. CT scan of the abdomen revealed free gas and fluid in the left iliac fossa, as well as a foreign body penetrating the sigmoid colon. Emergency laparotomy was performed. A plastic stent was found perforating the sigmoid colon through a diverticulum. The rest of the sigmoid colon was intact presenting only uncomplicated diverticula. Hartmann’s operation was performed, involving the diseased segment, together with part of the descending colon due to profound diverticulosis. Patient’s post-surgical course was uneventful and was discharged on postoperative day 10. Discussion Migration of a biliary stent can cause life-threatening complications such as perforation of the intestine and peritonitis. The migration of the stent from the biliary tree may be mostly asymptomatic except in cases of intestinal perforation that immediate surgery is the proper treatment option. On the other hand, even in cases of benign lesions of the bile duct, the stent should be removed immediately after dislocation in order to reduce the risk of secondary complications such as obstruction, infection or perforation. Conclusion In cases of non-complicated stent migration endoscopic retrieval is the indicated treatment. In patients who suffer serious complications due to stent dislocation, emergency surgery may be the proper treatment option.
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Affiliation(s)
- Petros Siaperas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Argyrios Ioannidis
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Andreas Skarpas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Argiris Angelopoulos
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Ioannis Drikos
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Ioannis Karanikas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
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A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia. Case Rep Surg 2015; 2015:860286. [PMID: 26273488 PMCID: PMC4529966 DOI: 10.1155/2015/860286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.
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Mady RF, Niaz OS, Assal MM. Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess. BMJ Case Rep 2015; 2015:bcr2014206805. [PMID: 25870211 PMCID: PMC4401935 DOI: 10.1136/bcr-2014-206805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 01/30/2023] Open
Abstract
Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.
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Tolan HK, Sriprayoon T, Akaraviputh T. Unusual penetration of plastic biliary stent in a large ampullary carcinoma: A case report. World J Gastrointest Endosc 2012; 4:266-268. [PMID: 22720129 PMCID: PMC3377870 DOI: 10.4253/wjge.v4.i6.266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic biliary stenting is a well-established treatment of choice for many obstructive biliary disorders. Commonly used plastic endoprostheses have a higher risk of clogging and dislocation. Distal stent migration is an infrequent complication. Duodenum is the most common site of a migrated biliary stent. Intestinal perforation can occur during the initial insertion or endoscopic or percutaneous manipulation, or as a late consequence of stent placement. A 52-year-old male who presented with obstructive jaundice underwent endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. However, jaundice did not improve and he then underwent ERCP which revealed the plastic stent penetrating the ampullary tumor into the duodenal wall causing malfunction of the stent. A new plastic stent was inserted and the patient underwent Whipple's operation. He is currently doing well after the operation.
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Affiliation(s)
- H Kerem Tolan
- H Kerem Tolan, Tassanee Sriprayoon, Thawatchai Akaraviputh, Department of Surgery, Division of General Surgery, Minimally Invasive Surgery Unit, Siriraj Gastrointestinal Endoscopy Center, Mahidol University, Bangkok 10700, Thailand
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9
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Bagul A, Pollard C, Dennison AR. A review of problems following insertion of biliary stents illustrated by an unusual complication. Ann R Coll Surg Engl 2010; 92:W27-31. [PMID: 20501006 DOI: 10.1308/147870810x12659688852239] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. METHODS A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. FINDINGS Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.
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Affiliation(s)
- Atul Bagul
- HPB Department, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
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10
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Hunter K, Siddiqui T, Komolafe O, Chong D. Colonic perforation secondary to migrated biliary stent. Case report of an unusual complication, and literature review. Scott Med J 2010. [DOI: 10.1258/rsmsmj.55.1.57i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endoscopic stents are widely used to facilitate biliary drainage in hepatic, biliary and pancreatic conditions. Migration of the stent is a potentially serious complication. We report a case of migration of a biliary stent to the sigmoid colon at which point the stent perforated the colon and become lodged subcutaneously. The patient was managed successfully by local exploration to retrieve the stent without bowel resection. We also review the literature on complications caused by migrated biliary stents.
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Affiliation(s)
- K Hunter
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - T Siddiqui
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Oo Komolafe
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Dcs Chong
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
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Akbulut S, Cakabay B, Ozmen CA, Sezgin A, Sevinc MM. An unusual cause of ileal perforation: report of a case and literature review. World J Gastroenterol 2009; 15:2672-2674. [PMID: 19496201 PMCID: PMC2691502 DOI: 10.3748/wjg.15.2672] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Revised: 04/27/2009] [Accepted: 05/04/2009] [Indexed: 02/06/2023] Open
Abstract
An ileal perforation resulting from a migrated biliary stent is a rare complication of endoscopic stent placement for benign or malignant biliary tract disease. We describe the case of a 59-year-old woman with a history of abdominal surgery in which a migrated biliary stent resulted in an ileal perforation. Patients with comorbid abdominal pathologies, including colonic diverticuli, parastomal hernia, or abdominal hernia, may be at increased risk of perforation from migrated stents.
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12
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Abstract
Peri-ampullary and hepatic malignancies will frequently present with obstructive jaundice. For unresectable tumors, effective and lasting decompression of the biliary tree is essential to improve quality of life and survival. An overview of present treatment modalities for palliation of obstructive jaundice is provided, including a systematic review of the English literature regarding the optimum choice of palliation.
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Namdar T, Raffel AM, Topp SA, Namdar L, Alldinger I, Schmitt M, Knoefel WT, Eisenberger CF. Complications and treatment of migrated biliary endoprostheses: A review of the literature. World J Gastroenterol 2007; 13:5397-9. [PMID: 17879415 PMCID: PMC4171335 DOI: 10.3748/wjg.v13.i40.5397] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.
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Affiliation(s)
- Thomas Namdar
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Moorenstrasse 5, Dusseldorf 40225, Germany.
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Vertical Rotation and Impaction to the Choledochal Duct of a Migrated Biliary Self-expanding Metal Stent. Surg Laparosc Endosc Percutan Tech 2007; 17:416-7. [DOI: 10.1097/sle.0b013e3180959b27] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Akimboye F, Lloyd T, Hobson S, Garcea G. Migration of endoscopic biliary stent and small bowel perforation within an incisional hernia. Surg Laparosc Endosc Percutan Tech 2006; 16:39-40. [PMID: 16552378 DOI: 10.1097/01.sle.0000202198.74569.5a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Long-term complications from biliary stents, such as migration and perforation, are unusual but may occur. Distal perforations most commonly involve the colon or distal ileum. This report describes the case of a perforated small bowel, secondary to a stent trapped within an incisional hernia. Patients with comorbid abdominal pathologies, including colonic diverticulae or abdominal herniae, may be at increased risk of perforation from migrated stents.
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Affiliation(s)
- F Akimboye
- Department of Surgery, Pilgrim Hospital, Sibsey Road, Boston, Lincs, PE21 9QS, UK
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Diller R, Senninger N, Kautz G, Tübergen D. Stent migration necessitating surgical intervention. Surg Endosc 2003. [PMID: 14508668 DOI: 10.1007/s00464-002-9163-5.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Internal drainage with transhepatically or endoscopically placed endoprostheses has been used for many years as a temporary or definitive treatment for biliary tract obstruction. As a late complication, stent migration may occur. METHODS We reviewed our records to identify patients who were operated on for a migrated endoprosthesis that was causing complications. In all, five such patients were identified. RESULTS One patient had a large bowel perforation. Bowel penetration led to an interenteric fistula in one patient and to a biliocolic fistula formation in another. Small bowel distension was found in two patients. Surgical treatment consisted of local excision in three patients, segmental resection in one patient, and a bypass operation in the patient with biliocolic fistula. Postoperatively, four patients recovered without problems, but one patient died during a complicated postoperative course. CONCLUSION If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications.
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Affiliation(s)
- R Diller
- Department of General Surgery, University Clinic of Muenster, Waldeyerstrasse 1, D-48149 Münster, Germany.
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