A Potentially Fatal Complication of Biliary Stent Migration

Abstract

A 77-year-old woman undergoing chemotherapy for mantle cell lymphoma presented with acute lower abdominal pain and pneumoperitoneum. Emergency laparotomy revealed a perforation of the sigmoid colon due to a migrated biliary stent requiring sigmoid resection and colostomy formation. This case highlights the potential complications that may arise from migrated biliary stents and discusses the management options in such patients.

A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent

“…Benign biliary strictures were associated with a higher risk of migration than malignant biliary strictures [ 4 ]. Thus, patients affected by a benign disease exhibited a higher frequency of migration [ 7 ].…”

“…Studies in the literature have also reported perforations in the liver, sigmoid colon, caecum, and pancreas [ 3 , 10 ]. A literature review performed in 2007 described 11 cases in which migrating stents caused colonic perforation [ 7 ]. A number of studies have also reported that bowel wall penetration is associated with complications such as perforation of the small bowel, sigmoid diverticular perforation, and enteroenteric fistula formation [ 4 ].…”

“…The incidence of distal migration has increased in the presence of post-sphincterotomy or sphincter of Oddi dysfunction, long stents (longer than 7 cm), and benign disorders particularly in papillary stenosis [ 6 ]. In addition, the distal migration of stents was determined to be closely related to post-cholecystectomy strictures and proximal strictures [ 7 ]. In the present study, the biliary stent migrated distally and was located extraluminally in the pelvic area.…”

Endoscopic and percutaneous extraction of two biliary stents migrated to distinct abdominal locations

“…Endoscopic placement of biliary stents is a well-established, safe and minimally invasive procedure, commonly used in the treatment of a wide variety of biliary disorders 1. Biliary stent migration is an unusual event2 occurring in up to 10% of patients 3.…”