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      A Fatal Complication: Intestinal Perforation Secondary to Migration of a Biliary Stent

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          Summary

          Background

          Stent insertion is widely performed to restore biliary drainage in hepatic, biliary, and pancreatic obstructive conditions. Intestinal perforation due to the migration of these stents is an extremely rare late-term complication that is associated with a high rate of mortality. The current report aimed at presenting the radiological findings of a case of extraluminal biliary stent migration into the pelvic region that caused intestinal perforation.

          Case Report

          We report a case of an 85-year-old male with a history of previous stent insertion who presented with a sudden – onset severe abdominal pain. An abdominal multidetector computed tomography (MDCT) revealed a tubular foreign body density, compatible with intestinal perforation due to migration of the biliary stent.

          Conclusions

          Biliary stent insertion becomes a more common procedure. This serious complication must always be remembered in patients presenting with abdominal pain after stent insertion.

          Related collections

          Most cited references9

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          Complications and treatment of migrated biliary endoprostheses: a review of the literature.

          Endoscopic biliary stent insertion is a well-established procedure. It is especially successful in treating postoperative biliary leaks, and may prevent surgical intervention. A routine change of endoprostheses after 3 mo is a common practice but this can be prolonged to 6 mo. We reported a colonic perforation due to biliary stent dislocation and migration to the rectosigmoid colon, and reviewed the literature.
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            Retroperitoneal perforation of the duodenum from biliary stent erosion.

            Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.
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              Biliary stent migration with duodenal perforation.

              Intestinal perforation from a migrated biliary stent is a known complication of endoscopic biliary stent placement. We present a case of stent migration and resultant duodenal perforation after stent placement for a malignant biliary stricture in a 52-year-old woman. We review the current literature on the diagnosis and management of stent migration and intestinal perforation after endoscopic stent placement for biliary strictures. A plain abdominal radiograph is necessary for early diagnosis of biliary stent migration. If a stent becomes lodged in the gastrointestinal tract, endoscopic or operative extraction of the stent is necessary to prevent subsequent intestinal perforation and peritonitis. Intestinal perforation secondary to biliary stent dislocation should be considered in all patients presenting with fever and abdominal pain after biliary stent insertion. Any abnormality that prevents stent migration through the intestinal tract such as gastroenterostomy, abdominal wall hernia, extensive adhesions or colonic divertucula may be a contraindication for insertion of a plastic biliary stent because of increased perforation risk.
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                Author and article information

                Journal
                Pol J Radiol
                Pol J Radiol
                Pol J Radiol
                Polish Journal of Radiology
                International Scientific Literature, Inc.
                1733-134X
                1899-0967
                2016
                17 April 2016
                : 81
                : 170-172
                Affiliations
                [1 ]Department of Radiology, Kahramanmaraş Necip Fazıl Şehir Hastanesi, Kahramanmaraş, Turkey
                [2 ]Department of Radiology, Afyon Kocatepe Üniversitesi Tıp Fakültesi, Afyonkarahisar, Turkey
                Author notes
                Author’s address: Gülay Güngör, Department of Radiology, Kahramanmaraş Necip Fazıl Şehir Hastanesi, Kahramanmaraş, Turkey, e-mail: drgulaygungor@ 123456gmail.com
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                896231
                10.12659/PJR.896231
                4836307
                27141238
                70bcd7ec-dd09-4981-84ca-55cc85ad617c
                © Pol J Radiol, 2016

                This is an open access article. Unrestricted non-commercial use is permitted provided the original work is properly cited.

                History
                : 11 October 2015
                : 26 October 2015
                Categories
                Case Report

                Radiology & Imaging
                biliary tract,intestinal perforation,multidetector computed tomography,stents

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