Sigmoid Diverticulitis and Perforation Secondary to Biliary Stent Migration

Abstract

Introduction. Biliary stent migration occurs in 5-10% of patients. Generally, this is a benign process and stents pass or are retrieved endoscopically. In rare instances, intestinal perforation has occurred. Presentation of Case. A 79-year-old female presented with a one-day history of abdominal pain. She had undergone an ERCP four weeks previously for primary choledocholithiasis during which time a sphincterotomy and sphincteroplasty were performed, and stents were placed in the common bile duct. CT scan of the abdomen and pelvis demonstrated a biliary stent that had migrated into the sigmoid colon, appearing to perforate the colon with free air throughout the abdomen. Patient was taken for diagnostic laparoscopy and noted to have biliary stent perforating the sigmoid colon. Procedure was converted to open, and Hartmann’s procedure was performed with end colostomy. Conclusion. Generally, biliary stent migration is a benign process, but in rare instances, intestinal perforation has occurred. Sites of perforation include the duodenum, distal small bowel, and colon. Perforation is more common with an additional pathology present such as hernias or diverticular disease. Migration and perforation also appear more common with straight biliary stents. In patients with known diverticular disease and straight biliary stents, considerations should be made for early stent removal.

Re: Bowel perforation: a ‘not so rare’ complication of biliary stent migration

“…In addition, in table 1, only case number 1 had pigtail and straight both stents, but on checking the original report, we found that migrated stent was straight biliary stent. 2 From the available literature, Yagnik et al (2018) observed that most reported cases of luminal perforation with biliary stents had been associated with a straight biliary stent. Therefore, they suggest that double pigtail stents are used to prevent such perforation and migration as pigtail stents are less likely to migrate distally.…”

Removal of proximally migrated biliary stents by using single-operator cholangioscopy

“…3 The literature includes reports of adverse events that can be broadly classified into perforation or obstruction of the intestines, intra-abdominal sepsis, fistula formation, appendicitis, and necrotizing fasciitis. [3][4][5] On rare occasions, other cavities or organs can be affected, such as the pleura or the pancreas. It is, therefore, useful to advance our knowledge of the available tools and techniques of removal.…”

Sigmoid Perforation by a Migrated Plastic Biliary Stent

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

“…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].…”

“…The ideal interval for scheduled removal depends on the pathology but should not exceed 3-4 months. 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].…”