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      Duodenal diverticulum at the site of the major papilla may be a risk factor for biliary stent migration

      case-report
      , ,
      Journal of Surgical Case Reports
      Oxford University Press

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          Abstract

          Stent migration is a well-documented complication following biliary stent insertion. The majority of cases demonstrate passage through the bowel without incident; however, migration may also result in complications, including bowel obstruction or perforation requiring urgent intervention. Risk factors for stent migration comprise of disease pathology as well as stent characteristics including dimension, material and number. Although duodenal diverticulae has been noted as a risk factor for duodenal perforation or obstruction post stent migration, it has yet to be implicated as a contributor to migration itself. Here, we present an unusual case of ileal obstruction secondary to biliary stent impaction, in which the presence of a duodenal diverticulum may be considered a viable risk factor for stent migration.

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          A review of problems following insertion of biliary stents illustrated by an unusual complication

          The management of obstructive jaundice resulting from both benign and malignant causes relies heavily on minimally invasive techniques and particularly with the insertion of biliary endoprostheses. Migration of these biliary stents is a well-documented problem and can result in a variety of complications including perforation, intra-abdominal sepsis, fistulae formation, obstruction and appendicitis. A literature search was performed using PubMed examining case reports, published abstracts and reviews to date (2009). In addition, we report a left groin abscess as a previously unreported complication following migration of a biliary endoprosthesis. Stent migration can lead to serious complications and produce significant morbidity and mortality. Symptomatic patients especially those with other co-morbid abdominal pathologies such as colonic diverticulae, parastomal hernia or abdominal hernias may be at an increased risk of perforation especially when straight plastic stents are used.
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            The challenging diagnosis and treatment of duodenal diverticulum perforation: a report of two cases

            Background The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. Case presentation We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. Conclusions Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.
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              A rare cause for Hartmann’s procedure due to biliary stent migration: A case report

              Highlights • Migration of a biliary stent can cause life-threatening complications. • When a stent migration occurs, in case of complications, surgical removal is the only treatment option. • Among the complications associated with stent migration, intestinal bleeding, obstruction and perforation are of outmost importance.
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                Author and article information

                Contributors
                Journal
                J Surg Case Rep
                J Surg Case Rep
                jscr
                Journal of Surgical Case Reports
                Oxford University Press
                2042-8812
                March 2021
                24 March 2021
                24 March 2021
                : 2021
                : 3
                : rjab079
                Affiliations
                Department of Surgery , The Wollongong Hospital , Wollongong, New South Wales, Australia
                Department of Surgery , The Wollongong Hospital , Wollongong, New South Wales, Australia
                Department of Surgery , The Wollongong Hospital , Wollongong, New South Wales, Australia
                Author notes
                Correspondence address. The Wollongong Hospital—Loftus Street, Wollongong, NSW 2500, Australia. Tel: +61 (2) 4222 5000; Fax: +61 (2) 4222 1337; E-mail: tmorosin@ 123456live.com.au
                Author information
                https://orcid.org/0000-0001-5753-8344
                Article
                rjab079
                10.1093/jscr/rjab079
                7995517
                33815756
                6dd19990-b107-4761-a28b-874ee66d50ea
                Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author(s) 2021.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 25 January 2021
                : 12 February 2021
                Page count
                Pages: 3
                Categories
                Case Report
                AcademicSubjects/MED00910
                jscrep/080

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