Spontaneous Choledochoduodenal Fistula after Metallic Biliary Stent Placement in a Patient with Ampulla of Vater Carcinoma

Abstract

Biliary stent-related enteric perforations are very rare complications that are caused by the sharp end of a metallic stent, stent migration, or tumor invasion. Moreover, the choledochoduodenal fistula resulting from metallic biliary stent-induced perforation is extremely rare. Here, we report a case in which a spontaneous choledochoduodenal fistula occurred after biliary metallic stent placement in a patient with an Ampulla of Vater carcinoma but was successfully managed by supportive treatments, including nasobiliary drainage. This case might have occurred as the result of a rupture of the bile duct following pressure necrosis and inflammation caused by impacted calculi and food materials over the tumor ingrowth in the uncovered biliary stent.

Unusual reintervention through a fistula for ampullary penetration of a plastic stent in malignant distal biliary obstruction

“…Most dislocated biliary PS rarely cause damage to the digestive tract; these typically stay in situ or in the digestive tract and are eventually passed out of the body naturally. In the present case, we successfully placed the second PS through the fistula with the first dislocated PS intact as in previous reports …”

Choledochoduodenal Fistula after the Placement of a Partially Covered Metal Stent for Unresectable Pancreatic Cancer

“…Various etiologies of CDF have been reported, such a penetrating peptic ulcer (1), choledocholithiasis (2), hepatobiliary (5,8,9) and pancreatic cancer (6,7), and iatrogenic injury, including that by an endoscopic prosthesis (4-9). CDF is a relatively rare, delayed complication of metal stent placement, which is related to bile duct wall injury due to stent migration or the sharp end of the metal stent (9). CDF cases associated with SEMS were identified in the PubMed database using the search terms "choledochoduodenal fistula" and "self-expandable metallic stent," or "metal stent," and 6 additional cases were found (hereafter referred to as reference cases).…”

“…The primary causes of CDF are choledocholithiasis and a penetrating peptic ulcer (2,3). CDF is also a relatively rare, delayed complication of metal stent placement, which has been reported to be caused by bile duct wall injury due to stent migration or the sharp end of the metal stent with a poor prognosis (4)(5)(6)(7)(8)(9). We herein present a rare case of CDF after the placement of a partially covered metal stent for distal common bile duct obstruction in a patient with unresectable pancreatic cancer.…”

Stone-Induced Purulent Choledocoduodenal Fistula Presenting with Ascending Cholangitis

“…A distal CDF connects the duodenum to a region within 2 cm of the distal common bile duct (CBD), whereas a proximal CDF drains ≥2 cm above the junction of CBD to the papilla 1,2. Spontaneous CDFs are more common than post-surgical CDFs, and they are usually caused by stones in the gallbladder or CBD (90%), peptic ulcer diseases (6%), malignancy, trauma, Crohn’s disease, or migration of a biliary clip or a metallic biliary stent 3-6. There are no symptoms that are pathognomonic for CDF.…”