Biliary obstruction necessitating choledochojejunostomy as a complication of endovascular coil erosion

Abstract

We report the case of a 55-year-old patient presenting with biliary obstruction caused by coil migration from a recently performed embolization of a post-traumatic gastroduodenal artery pseudoaneurysm. Based on imaging findings, biliary drain placement was initially performed and the subsequent endoscopy demonstrated coil erosion into the common bile duct and duodenum, resulting in choledochoduodenal fistula. Choledochojejunostomy was thereafter performed to bypass the area of injury.

Endovascular coil erosion into the duodenum following gastroduodenal artery angioembolization

“…In previously reported cases, symptomatic patients with coil migration underwent or were planned to undergo removal of the coil. 1,3,4 A laparotomy and duodenotomy to remove the coil has been previously reported; 5 however, given our patient was asymptomatic and in the context of significant comorbidities, the risks of major surgery were thought to outweigh the benefit of coil extraction in the elective setting. It is worth noting that spontaneous passage of a migrated coil has been previously reported without significant sequelae and therefore this approach would seem reasonable.…”

“…Abdominal cocoon, also being called sclerosing peritonitis or sclerosing encapsulating peritonitis, refers to partial or complete encapsulation of small bowel by fibrotic peritoneum that may cause acute or chronic intestinal obstruction. 1 Abdominal cocoon was first described by Foo et al in 1978. 2 Here, we report a case of primary abdominal cocoon presented with intestinal obstruction.…”

“…NKX3.1 is more sensitive than prostate-specific antigen for detecting metastatic prostatic tissue and has almost 100% specificity. 1 Five months following angioembolization, the patient was admitted for elective oesophagogastroduodenoscopy and biliary stent removal. At the time of the procedure, a metallic foreign body was identified protruding from the mucosa of the first part of the duodenum and through the pylorus (Fig.…”

“…Coil migration following angioembolization of visceral artery pseudoaneurysms is a rare complication of which cases have previously been documented in the literature, most commonly in the setting of renal and splenic artery pseudoaneurysms. 1,2 Erosion of an endovascular coil into the stomach has previously been reported to cause abdominal pain, weight loss, dyspepsia and severe anaemia requiring blood transfusion. 3,4 This article reports a case of asymptomatic coil migration into the duodenal lumen following GDA pseudoaneurysm angioembolization identified incidentally at endoscopy and is the first reported case of vascular coil erosion through the duodenum in the literature.…”

“…Coil migration following angioembolization of visceral artery pseudoaneurysms is a rare complication of which cases have previously been documented in the literature, most commonly in the setting of renal and splenic artery pseudoaneurysms . Erosion of an endovascular coil into the stomach has previously been reported to cause abdominal pain, weight loss, dyspepsia and severe anaemia requiring blood transfusion .…”