Intestinal perforation from a migrated biliary stent is a rare complication after endoscopic stent placement for benign biliary stricture. We provide the first description of stent migration and distal small-bowel perforation after stent placement for biliary anastomotic stricture in a liver transplant recipient. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic or percutaneous stent placement for benign and malignant biliary strictures. Early diagnosis and treatment of biliary stent migration and subsequent intestinal perforation are essential in transplant patients, in whom immunosuppression sometimes blunts signs and symptoms of intestinal perforation.
Conflicts in Iraq and Afghanistan have resulted in an increased number of United States service members (SM) with upper extremity amputations, resulting in new prostheses and increased research in the field. As of July 2014, there have been 1,648 patients suffering limb loss since the start of the conflicts, 511 of which involve multiple limb amputations (Military Amputee Patient Care Program Database, Extremity Trauma and Amputation Center of Excellence, 2014). Walter Reed National Military Medical Center has seen 1,224 of 1,648 returning SM with amputations. Of the total number of injuries, 287 traumatic amputations or 17.4 % of these involve an upper extremity (Military Amputee Patient Care Program Database, Extremity Trauma and Amputation Center of Excellence, 2014). Increased military support and funding have led to the advancement of research and development of new technologies. Occupational therapy amputee care has evolved and been documented in publications outlying treatment protocols that describe rehabilitation with this population (Smurr et al., J Hand Ther, 21(2):160-176, 2008). This article will serve as an overview of the current state of rehabilitative care for the military upper extremity amputee, implications for care, advances in the field, and research needs and initiatives.
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