Two-stage complications after endoscopic retrograde cholangiopancreatography comprising early retroperitoneal perforation and delayed biliary stent migration: A case report

doi:10.3748/wjg.123215

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Case Report

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 28, 2026; 32(48): 123215
Published online Dec 28, 2026. doi: 10.3748/wjg.123215

Two-stage complications after endoscopic retrograde cholangiopancreatography comprising early retroperitoneal perforation and delayed biliary stent migration: A case report

Suo-Lang Danzeng, Yong-Hao Chen, Xi Zha, Qiang Wang

Suo-Lang Danzeng, Xi Zha, Department of Gastroenterology, The People’s Hospital of Xizang Autonomous Region, Lhasa 850000, Tibet Autonomous Region, China

Yong-Hao Chen, Qiang Wang, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Co-first authors: Suo-Lang Danzeng and Yong-Hao Chen.

Co-corresponding authors: Xi Zha and Qiang Wang.

Author contributions: Danzeng SL and Chen YH collected and analyzed the clinical data, drafted the manuscript, contributed equally to this work, thus qualified as the co-first authors of the paper; Danzeng SL, Chen YH, Zha X and Wang Q designed the study; Zha X and Wang Q contributed to patient management and data interpretation, critically revised the manuscript as the co-corresponding authors; all authors read and approved the final manuscript.

AI contribution statement: AI tools (specifically ChatGPT) were used solely for linguistic refinement. No AI tool was involved in the generation of interpretation of results, or formulation of conclusions. All AI-generated outputs were critically reviewed and revised by the authors.

Supported by The Natural Science Foundation of Xizang Autonomous Region of China, No. XZZR202402007(W); The Science and Technology Projects of Xizang Autonomous Region of China, No. XZ202501JD0021 and No. XZ202501ZY0072; and the Beijing Municipal Health Commission Research Ward Excellence Clinical Research Program No. BRWEP2024W034010107.

Informed consent statement: Written informed consent was obtained from the patient for publication of this article.

Conflict-of-interest statement: The authors have no conflicts of interest to declare.

CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).

Corresponding author: Qiang Wang, MD, Associate Chief Physician, Associate Professor, Department of Gastroenterology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing 100730, China. pekingunion@aliyun.com

Received: May 13, 2026
Revised: July 16, 2026
Accepted: August 5, 2026
Published online: December 28, 2026
Processing time: 175 Days and 18.3 Hours

Abstract

BACKGROUND

Endoscopic retrograde cholangiopancreatography (ERCP)-related complications vary in timing, mechanism, severity, and management strategy. Early suspected perforation requires prompt assessment to determine whether conservative or surgical treatment is appropriate, whereas delayed stent-related complications require planned surveillance and timely intervention. Distinguishing these different complication patterns remains clinically challenging. We report a rare case of sequential post-ERCP complications: Early suspected retroperitoneal perforation successfully managed conservatively, followed by delayed biliary stent migration causing sigmoid colon perforation requiring emergency surgery.

CASE SUMMARY

A 62-year-old woman presented with intermittent abdominal pain and was diagnosed with choledocholithiasis with biliary dilatation. She underwent ERCP with sphincterotomy, balloon dilation, partial stone extraction, and biliary plastic stent placement. During stone extraction, contrast extravasation raised suspicion of perforation. Post-procedure computed tomography showed pneumobilia and extensive retroperitoneal extraluminal gas with mediastinal extension. Because she remained hemodynamically stable without progressive peritoneal signs, conservative management was performed, resulting in clinical and radiological improvement. More than 2 months later, she was readmitted with abdominal pain and peritoneal signs. Imaging revealed distal migration of the biliary stent into the sigmoid colon with free intraperitoneal air. Emergency laparotomy confirmed sigmoid colon perforation caused by the migrated stent. The stent was removed, the colonic defect was repaired, and loop ileostomy and drainage were performed, followed by satisfactory recovery.

CONCLUSION

Stable post-ERCP retroperitoneal perforation may be managed conservatively, but retained biliary stents require timely surveillance.

Keywords: Endoscopic retrograde cholangiopancreatography; Retroperitoneal perforation; Biliary stent migration; Sigmoid colon perforation; Case report

Core Tip: This case illustrates two-stage complications after endoscopic retrograde cholangiopancreatography (ERCP), including early suspected retroperitoneal perforation and delayed biliary stent migration causing sigmoid colon perforation. These complications differ in timing, mechanism, clinical significance, and management strategy. Early suspected retroperitoneal perforation may be treated conservatively in carefully selected stable patients, whereas delayed stent-related bowel perforation requires timely surgical intervention. This case emphasizes the need for close clinical assessment, dynamic radiological evaluation, and planned follow-up after ERCP.