Colonic diverticular perforation by a migrated biliary stent

Abstract

Rationale: Plastic endobiliary stents, after endoscopic retrograde cholangiopancreatography, can get spontaneously dislocated from the common bile duct and migrate intothe distal bowel. Most migrated biliary stents are removed with the passing of stool. However, migrated biliary stents can cause bowel perforation, albeit rarely, and surgical intervention may be required. Recently, we observed a colonic diverticular perforation caused by a migrated biliary stent, and we have reported this case with a review of the literature. Patients concerns: A 74-year-old man presented with severe right lower quadrant pain after biliary stent insertion 1month ago. Diagnoses: Abdominal computed tomography revealed perforation of the proximal ascending colon by the migrated biliary stent, combined with localized peritonitis. Interventions: Emergency diagnostic laparoscopic examination revealed penetration of the proximal ascending colon by the plastic biliary stent, and right hemicolectomy was performed. Outcomes: On pathological examination, colonic diverticular perforation by the biliary stent was confirmed. The patient was discharged without any additional complications. Lessons: Endoscopic retrograde cholangiopancreatography endoscopists must always be cautious of the possibility of stent migration in patients with biliary stents in situ. In cases of biliary stent dislocation from the common bile duct in asymptomatic patients, follow-up with serial, plain abdominal radiographs, and physical examination is needed until confirmation of spontaneous passage through stool. In symptomatic cases suggesting peritonitis, abdominal computed tomography scan confirmation is needed, and early intervention should be considered.

Rare Complication of Sigmoid Colon Perforation by Migrated Plastic Biliary Stent: Two Case Reports and Literature Review

“…Bowel perforation is an extremely rare event but a serious complication and can occur in any part of the small bowel or large bowel. Plastic biliary stent migration to the colon is an extremely rare event: from 1994 to 2021, only 30 reports were published according to Park TY et al case review [10]. Sigmoid colon seems to be the most involved segment, and the colonic diverticulum is the strong risk factor that contributes to bowel perforation.…”

Cecal Perforation Induced by Migrated Biliary Stent as a Rare Complication of ERCP: A Case Report and Literature Review

“…Kawaguchi et al stated that the potential risk factors for stent migration include stents with large diameters, long biliary stents, straight-type stents, stent duration >1 month, CBD diameter >10 mm, and history of sphincterotomy [7]. A retrospective cohort study showed that biliary stent migration occurred more frequently in benign types of biliary obstruction [8].…”

“…Distally migrated stents are usually passed spontaneously through the gastrointestinal tract or can be retrieved using endoscopy and fluoroscopy, but less than 1% may cause intestinal perforation, which is rare [2,4]. The risk of bowel perforation in stent migration is associated with structural bowel abnormalities or variations, such as postoperative bowel adhesion, diverticula, abdominal wall hernias, or strictures [8]. According to Zorbas et al, a systematic review of literature from 2000 until 2020 found 81 cases of bowel perforation induced by migrated biliary stents.…”

“…In addition, Park et al have analyzed 30 cases of colon perforation caused by distal migrated biliary stents. They reported that most cases were associated with colonic diverticulum (20 out of 30 cases), and the most commonly involved colonic segment was the sigmoid colon (25 sigmoid colons, 1 cecum, 1 ascending colon, 1 splenic flexure, 1 rectum, and 1 appendix) [8].…”

Minimally invasive management of an ascending colonic perforation secondary to distal biliary stent migration: a multidisciplinary, novel laparoendoscopic approach

“…Furthermore, Park et al ., in a review of 30 cases between 1994 and 2021 of biliary stent migration to the colon, reported the majority of colonic perforations occurred in the sigmoid colon, with only one case of perforation each in the ascending colon and cecum [ 10 ]. This case of ascending colon perforation adds to the existing literature and reinforces that a high index of suspicion for perforation with stent migration should be considered for all segments of the small bowel and colon.…”