Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Abstract

Background: Endoscopic retrograde biliary drainage (ERBD) is the most frequently performed procedure for treating benign or malignant biliary obstruction. Although duodenal perforations secondary to the biliary plastic stent are quite rare, they can be life-threatening. The treatment strategies for such perforations are diverse and continue to be debated. Case presentation: We report three cases of duodenal perforation due to the migration of biliary plastic stents that were successfully managed using an endoscope. The three patients were admitted on complaints of abdominal pain after they underwent ERBD. Abdominal computerized tomography (CT) revealed migration of the biliary plastic stents and perforation of the duodenum. Endoscopy was immediately performed, and perforation was confirmed. All migrated stents were successfully extracted endoscopically by using snares. In two of the three cases, the duodenal defects were successfully closed with haemostatic clips after stent retrieval, and subsequently, endoscopic nasobiliary drainage tubes were inserted. After the endoscopy and medical treatment, all three patients recovered completely. Conclusions: Duodenal perforations due to the migration of biliary stents are rare, and the treatment strategies remain controversial. Our cases and cases in the literature demonstrate that abdominal CT is the preferred method of examination for such perforations, and endoscopic management is appropriate as a first-line treatment approach.

Performance of plastic stents used for benign and malignant biliary strictures; experience of single high-volume endoscopy unit

“…Similarly, the prevalence of other complications was not significantly different from the available data. In a large meta-analysis, Cirocchi et al indicated that the risk of perforation during ERCP occurred in 0.6% of cases [27], and cholecystitis was observed in 0.5-5.4% of cases [29]. Duodenal perforation occurs mostly with straight stents [29] that was also shown in our study.…”

“…In a large meta-analysis, Cirocchi et al indicated that the risk of perforation during ERCP occurred in 0.6% of cases [27], and cholecystitis was observed in 0.5-5.4% of cases [29]. Duodenal perforation occurs mostly with straight stents [29] that was also shown in our study. In summary, in patients with benign biliary strictures stent replacement should be recommended in about 3.5 months intervals to avoid cholangitis caused by stent dysfunction, however, the length and location of the stricture affects stent patency duration.…”

Jejunal perforation secondary to migrated biliary stent

“…Biliary stent migration occurs in 5–10% of patients [ 6 ]. Although stent migration is reasonably common, gastrointestinal perforation secondary to stent migration is rare with an incidence of less than 1% [ 7 , 8 ]. The large majority of these perforations occur in the duodenum, with jejunal, ileal and colonic perforations being an even rarer entity.…”

“…Risk factors for colonic perforation in the setting of stent migration include diverticular disease and strictures [ 5 , 6 ]. Suggestion has been made that soft plastic pigtail stents opposed to straight plastic stents should be considered in patients with risk factors for perforation in setting of migration [ 5 , 8–10 ]. Biliary stent removal is usually achievable via endoscopic methods.…”

Small bowel perforation from a migrated biliary stent: A case report and review of literature

“…A serious potential consequence of stent migration is bowel perforation which can happen at any part of the small or large bowel, but fortunately has an incidence of less than 1%[ 3 , 4 ]. The majority of the case reports with bowel perforation secondary to migrated biliary stent describe duodenal or colonic perforations, with very few cases of small bowel perforations.…”