A review of problems following insertion of biliary stents illustrated by an unusual complication

Bagul, Atul; Pollard, C.; Dennison, Ashley R.

doi:10.1308/147870810x12659688852239

Cited by 46 publications

(74 citation statements)

References 48 publications

(59 reference statements)

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“…Según Johanson 13 , existe un elevado riesgo de migración proximal en las vías biliares cuando se asocia a estenosis malignas como el colangiocarcinoma, a las endoprótesis de mayor diámetro y a las endoprótesis de corta longitud; y la migración distal ocurre más frecuentemente en la estenosis papilar, no hallando otros factores de riesgo significativos en la migración distal. Se ha observado que la migración distal es más frecuente en las estenosis benignas que en las malignas, posiblemente debido a que las estenosis benignas son menos estrechas a causa de la desaparición de la inflamación y del edema de la mucosa de las vías biliares con el paso del tiempo, a diferencia de las estenosis malignas donde el tejido tumoral ancla la endoprótesis previniendo su migración 2,11,15 en otras estenosis benignas, excepto en la colangitis esclerosante primaria, probablemente secundario a la existencia del tejido fibroso que forma la estenosis. Al igual que Johanson 13 , ha hallado que en las estenosis biliares benignas las endoprótesis cortas tienden a migrar proximalmente, y las largas distalmente; sin encontrar diferencias significativas en relación con el calibre de la endoprótesis y la frecuencia y dirección de la migración.…”

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Perforación diverticular sigmoidea secundaria a la migración de endoprótesis biliar plástica

et al. 2013

Rev Chil Cir

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Sigmoid diverticulum perforation due to plastic biliary stent migrationBackground: Biliary stents are devices that are used to widen narrowed bile ducts, especially in malignant obstructions, although at present its use in benign biliopancreatic diseases is progressively increasing. Endoscopic placement of biliary stents is a well established procedure that is performed daily. Despite its frequency, has a complication rate of 5-10%, the most common are cholangitis and stent obstruction and there are others more rare and serious like pancreatitis, gastrointestinal bleeding, intestinal perforation and biliary stent migration. Case report: We report a 70-years-old male with a history of plastic biliary stent placement after open cholecystectomy because of choledocholithiasis, who arrived at the Emergency Department with symptoms of intestinal obstruction. After performing imaging studies, there was significant intestinal dilation and a biliary stent in the sigmoid colon. He underwent urgent surgical intervention, having the plastic biliary stent located in a sigmoid diverticulum. We performed removal of the stent and simple suture of the sigmoid diverticular perforation. Conclusion: Sigmoid diverticular perforation secondary to migration of a plastic biliary stent is a rare complication that can occur after placement of a stent in the bile duct. It must be suspected in all acute abdomens accompanied of radiological images demonstrating biliary stent migration because these patients often show atypical symptoms. ResumenIntroducción: Las endoprótesis biliares son dispositivos que se emplean para ampliar las vías biliares estenosadas, especialmente en las obstrucciones malignas, aunque actualmente su uso está aumentando progresivamente en las enfermedades benignas biliopancreáticas. La colocación endoscópica de las endoprótesis biliares es un procedimiento bien establecido que se realiza diariamente, aunque presenta una tasa de complicaciones de 5-10%, siendo las más frecuentes la colangitis y la obstrucción de la propia endoprótesis, existiendo otras más raras y graves como la pancreatitis, la hemorragia digestiva, la perforación intestinal y la migración de la endoprótesis biliar. Caso clínico: Varón de 70 años de edad con antecedentes de colocación de

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Section: Discussionunclassified

Perforación diverticular sigmoidea secundaria a la migración de endoprótesis biliar plástica

et al. 2013

Rev Chil Cir

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“…Distal migration occurs in 4% of the cases and is more common in benign than malignant biliary conditions and when a single straight stent is placed [1]. Despite being generally a benign process, in rare instances, distally migrated plastic stents can fail to pass, become trapped in the small bowel or colon (mainly, in the duodenum, distal ileum, or sigmoid colon) and cause serious injuries such as bowel perforations [2,3].…”

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“…Colonic perforations by migrated biliary plastic stents have been rarely described [2][3][4]. The sigmoid has been the colon segment most commonly involved.…”

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confidence: 99%

“…The sigmoid has been the colon segment most commonly involved. Diverticulosis, abdominal hernias, previous surgeries/adhesions, and the characteristics of the plastic stent itself (straight and long) are risk factors for this complication [2][3][4][5]. In selected cases, stent removal with closure of the perforation can be done endoscopically [5].…”

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confidence: 99%

“…Nevertheless, early stent removal can be prudent when there are risk factors for stent migration or for migration-related complications [4]. Whenever possible, the use of double pigtail biliary stents should be considered, since these are associated with less secondary complications than migrated straight stents [2].…”

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Sigmoid Perforation by a Migrated Plastic Biliary Stent

Marcos

Capelão

Atalaia-Martins

et al. 2019

GE Port J Gastroenterol

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Perfuração da sigmoide por uma prótese biliar plástica migrada Palavras Chave Perfuração intestinal · Colangiopancreatografia retrograda endoscópica · PróteseA 65-year-old female with a previous history of endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction and placement of a straight biliary plastic stent (5 cm long and 10 Fr in diameter) due to residual choledocholithiasis presented with spontaneous distal migration of the stent in the scheduled ERCP 6 weeks later. The residual stones were removed. However, an abdominal X-ray to confirm the passage of the stent was not carried out. A subsequent laparoscopic cholecystectomy was uneventfully performed. Asymptomatic, 1 year later, the patient underwent a screening colonoscopy that revealed a foreign body suggestive of a plastic biliary stent, impacted in the sigmoid colon, in an area of diverticula (Fig. 1). The computed tomography showed a tubular structure compatible with the biliary stent perforating the sigmoid colon with both tips (Fig. 2). The CT scan did not reveal additional complications, and the patient remained asymptomatic. After multidisciplinary discussion, a surgical approach was proposed. The patient underwent an uneventful laparoscopic surgery with successful stent removal and closure of the perforations (Fig. 3).Overall, biliary plastic stent migration (proximal and distal) occurs in 5-10% of the patients. Distal migration occurs in 4% of the cases and is more common in benign than malignant biliary conditions and when a single straight stent is placed [1].

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