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Alkhawaldeh IM, Shattarah O, AlSamhori JF, Abu‐Jeyyab M, Nashwan AJ. Late small bowel perforation from a migrated double plastic biliary stent: A case report and a review of literature of 85 cases from 2000 to 2022. Clin Case Rep 2023; 11:e7425. [PMID: 38028080 PMCID: PMC10658557 DOI: 10.1002/ccr3.7425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/13/2023] [Accepted: 05/16/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message This case highlights the importance of considering stent migration as a possible cause of intestinal perforation and the need for prompt surgical intervention. Abstract Endo-biliary stent displacement is rare but can cause intestinal perforation. An 85-year-old woman with a history of ERCPs and biliary stents experienced stomach pain and vomiting. She was diagnosed with small bowel perforation from migrated stents and underwent emergency laparotomy, bowel resection, and tension-free stapled anastomosis.
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Affiliation(s)
| | - Osama Shattarah
- General Surgery Department, School of MedicineMutah UniversityAl‐KarakJordan
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2
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Fujii Y, Matsumoto K, Miyamoto K, Matsumi A, Morimoto K, Terasawa H, Yamazaki T, Horiguchi S, Tsutsumi K, Kato H. Endoscopic treatment for duodenal perforation due to biliary stent dislocation: A case report and brief review of the literature. Medicine (Baltimore) 2022; 101:e31868. [PMID: 36482637 PMCID: PMC9726363 DOI: 10.1097/md.0000000000031868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Duodenal wall perforation by a dislocated biliary stent placed for biliary structure is rare but can be life-threatening. There are few reports on the management of stent-related duodenal perforation. PATIENT CONCERNS Three cases included in this study had undergone endoscopic retrograde cholangiopancreatography with placement of a plastic stent for biliary stricture. Two cases had symptoms (fever or abdominal pain), while other case showed no symptom after biliary stent placement. DIAGNOSES Dislocation of plastic stents was revealed on computed tomography or endoscopic images. Two patients were diagnosed with duodenal perforation due to distal migration of long stents with a straight shape on the distal side. One patient was diagnosed with fistula formation between the intrahepatic bile duct and duodenum due to perforation of a pigtail stent. INTERVENTIONS All cases could successfully be managed endoscopically with closure by hemoclips or stent replacement. OUTCOMES All 3 cases were improved after endoscopic treatment without any subsequent intervention. LESSONS Longer stents with a straight distal side are associated with a higher risk of duodenal perforation. Endoscopic management is appropriate as a first-line approach for a clinically stable patient. At the time of stent placement, we should pay attention to the length and type of stent.
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Affiliation(s)
- Yuki Fujii
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kazuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
- * Correspondence: Kazuyuki Matsumoto, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan, 2-5-1, Shikata-cho, Kita-ku, Okayama-city, Okayama 700-8558, Japan (e-mail: )
| | - Kazuya Miyamoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Akihiro Matsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kosaku Morimoto
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroyuki Terasawa
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Tatsuhiro Yamazaki
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shigeru Horiguchi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Koichiro Tsutsumi
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hironari Kato
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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Duodenal perforation due to migrated biliary stent: Case report. Int J Surg Case Rep 2022; 97:107354. [PMID: 35870218 PMCID: PMC9403011 DOI: 10.1016/j.ijscr.2022.107354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Biliary stents are frequently associated with various complications; however biliary stent migration causing duodenal perforation is rare and has only been reported in few cases. PRESENTATION OF CASE We present a case of 33 years old male with pain abdomen and fever for 2 days came to Emergency department. He had undergone open common bile duct exploration (CBD), clearance of stone and placement of CBD stent. In X-ray abdomen, biliary stent migration was suspected. CECT abdomen was done for the confirmation of diagnosis which showed migrated stent with duodenal perforation. Patient underwent exploratory laparotomy and Thal patch repair, pyloric exclusion, retrograde duodenostomy and feeding jejunostomy. Post-operative period was uneventful. DISCUSSION Biliary stents are used to relieve biliary obstruction. There is increasing use of endoscopic retrograde drainage via plastic endoprosthesis and so the related morbidities. One of the rare but serious complications is intestinal perforation and duodenal perforation is seen in most of the cases, explanation being the relative fixed position of the duodenum. CONCLUSION Although intestinal perforation is an uncommon complication following CBD stenting, we should suspect it in patients presenting with pain and fever.
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Zorbas KA, Ashmeade S, Lois W, Farkas DT. Small bowel perforation from a migrated biliary stent: A case report and review of literature. World J Gastrointest Endosc 2021; 13:543-554. [PMID: 34733414 PMCID: PMC8546564 DOI: 10.4253/wjge.v13.i10.543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/10/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel perforation from biliary stent migration is a serious potential complication of biliary stents, but fortunately has an incidence of less than 1%. CASE SUMMARY We report a case of a 54-year-old Caucasian woman with a history of Human Immunodeficiency virus with acquired immunodeficiency syndrome, chronic obstructive pulmonary disease, alcoholic liver cirrhosis, portal vein thrombosis and extensive past surgical history who presented with acute abdominal pain and local peritonitis. On further evaluation she was diagnosed with small bowel perforation secondary to migrated biliary stents and underwent exploratory laparotomy with therapeutic intervention. CONCLUSION This case presentation reports on the unusual finding of two migrated biliary stents, with one causing perforation. In addition, we review the relevant literature on migrated stents.
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Affiliation(s)
| | - Shane Ashmeade
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - William Lois
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
| | - Daniel T Farkas
- Department of Surgery, Bronx Care Health System, New York, NY 10457, United States
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García Cano J, Viñuelas Chicano M, Valiente González L. Straight plastic stents in tumors at the hepatic hilum and related duodenal perforations. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:383-384. [PMID: 33393343 DOI: 10.17235/reed.2020.7690/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We read with interest the paper on the endoscopic treatment of a duodenal perforation related to a plastic biliary stent that was reported by Roa et al. We would like to add some comments about biliary stents inserted during endoscopic retrograde cholangiopancreatography (ERCP) to palliate malignant jaundice in hilar strictures. It is our belief that the most convenient strategy in non-operable patients should be the insertion of at least one uncovered self-expanding metal stent.
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Stassen PM, de Jong DM, Poley JW, Bruno MJ, de Jonge PJ. Prevalence of and risk factors for stent migration-induced duodenal perforation. Endosc Int Open 2021; 9:E461-E469. [PMID: 33655050 PMCID: PMC7895667 DOI: 10.1055/a-1337-2321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023] Open
Abstract
Background and study aims The safety of transpapillary biliary drainage by stent placement through endoscopic retrograde cholangiography (ERC) may be compromised by the occurrence of stent migration-induced perforation of the duodenal wall (SMDP). We aimed to assess the prevalence rate, risk factors and clinical course of SMDP. Patients and methods This retrospective cohort study included all patients who underwent an ERC with biliary plastic stent placement, between January 2014 and December 2018. Patients with an SMDP were identified from our endoscopy complication registry. Results 1227 patients underwent an ERC, of whom 629 patients (51 %) with biliary plastic stent placement; in 304 patients (25 %) stents were placed for perihilar strictures. Thirteen patients with SMDP were identified. The prevalence was 2.1 % for patients with biliary plastic stent placement and 4.3 % for patients stented for a perihilar stricture. All SMDPs occurred in patients with a perihilar stricture and with stents ≥ 12 cm (range 12-20 cm). Another potential risk factor was stent insertion into the left liver lobe, which was present in 10 of 13 patients. In 10 of 13 patients, SMDP was clinically suspected. Three of 13 patients were asymptomatic and diagnosed at elective stent retrieval. Eight patients could be endoscopically treated with an over-the-scope clip. Four patients died due to abdominal sepsis despite repeated interventions. Conclusion SMDP is a rare but potentially life-threatening complication of ERC after transpapillary drainage for perihilar biliary strictures. Stents ≥ 12 cm and stent insertion into the left liver lobe may be associated risk factors.
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Affiliation(s)
- Pauline M.C. Stassen
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - David M. de Jong
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan-Werner Poley
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marco J. Bruno
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pieter J.F. de Jonge
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Gromski MA, Bick BL, Vega D, Easler JJ, Watkins JL, Sherman S, Lehman GA, Fogel EL. A rare complication of ERCP: duodenal perforation due to biliary stent migration. Endosc Int Open 2020; 8:E1530-E1536. [PMID: 33140007 PMCID: PMC7577786 DOI: 10.1055/a-1231-4758] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 05/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background and study aims Perforation of the duodenal wall opposing the major papilla due to a migrated pancreatobiliary stent rarely has been described in the literature as a complication of endoscopic retrograde cholangiopancreatography (ERCP). Factors associated with perforation from migrated stents from ERCP are unknown. Patients and methods This was a retrospective, observational study. Patients were identified from January 1, 1994 to May 31, 2019 in a prospectively maintained ERCP database. Results Eleven cases of duodenal perforation from migrated pancreatobiliary stents placed at ERCP were identified during the study period. All cases involved biliary stents, placed for biliary stricture management. The perforating stent was plastic in 10 cases (91 %). This complication occurred in one in 2,293 ERCP procedures in which a pancreatobiliary stent was placed. Conclusion This complication is more common with biliary stents compared to pancreatic stents. This may be related to the angle of exit of biliary stents being more perpendicular to the opposing duodenal wall and the near exclusive use of external pigtail plastic stents in the pancreatic duct. All perforating plastic stents were ≥ 9 cm in length. Longer stents may provide leverage for perforation with a migration event.
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Affiliation(s)
- Mark A. Gromski
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Benjamin L. Bick
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - David Vega
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jeffrey J. Easler
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James L. Watkins
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Stuart Sherman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen A. Lehman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan L. Fogel
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
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8
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Bernardo S, Freitas C, Lopes J, Ferreira CN, Marinho RT. Endoscopic closure of a duodenal perforation caused by early migration of a biliary plastic stent with an over-the-scope-clip. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:139-140. [PMID: 32919801 DOI: 10.1016/j.gastrohep.2019.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/27/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Sónia Bernardo
- Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
| | - Carlos Freitas
- Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - João Lopes
- Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Carlos Noronha Ferreira
- Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Rui Tato Marinho
- Serviço de Gastroenterologia e Hepatologia, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
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9
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Wang X, Qu J, Li K. Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature. BMC Gastroenterol 2020; 20:149. [PMID: 32398025 PMCID: PMC7216602 DOI: 10.1186/s12876-020-01294-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 05/05/2020] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Xiaopeng Wang
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Junwen Qu
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China
| | - Kewei Li
- Department of Biliary- Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong New Area, Shanghai, 200127, China.
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10
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Tsang CLN, O'Neill RS, Joseph CM, Palasovski T. Small Bowel Perforation Secondary to Biliary Stent Migration in an Incarcerated Inguinal Hernia. Cureus 2020; 12:e7268. [PMID: 32292679 PMCID: PMC7153812 DOI: 10.7759/cureus.7268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We describe the case of a 90-year-old female who presented with signs of a strangulated inguinal hernia. Further history revealed a paired biliary-pancreatic stent insertion three years prior for ascending cholangitis and a long-standing asymptomatic right inguinal hernia. Biochemistry revealed a slightly elevated C-reactive protein level of 65 mmol/L, but was otherwise unremarkable. Abdominal CT demonstrated two plastic biliary stents within an incarcerated right inguinal hernia. At the time of surgery, a 3-mm perforation due to the stents was identified in the small bowel within the hernia. The stents were retrieved via an enterotomy that was subsequently repaired with full-thickness interrupted sutures. A tissue-suture repair of the inguinal hernia was performed due to significant contamination of enteric contents in the operative field. The patient had an unremarkable recovery and was discharged four days after her operation. This is a very rare acute presentation of stent migration with only a handful of such reported cases in the literature. With the rising number of endoscopic biliary stenting procedures, these complications are likely to increase, and clinicians need to be aware of this possibility in patients with pre-existing hernias.
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11
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Jadallah K, Alzubi B, Sweidan A, Almanasra AR. Intraperitoneal duodenal perforation secondary to early migration of biliary stent: closure with through-the-scope clip. BMJ Case Rep 2019; 12:12/9/e230324. [PMID: 31488444 PMCID: PMC6731926 DOI: 10.1136/bcr-2019-230324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Endoscopic biliary stenting is a well-recognised method of palliation of malignant biliary obstruction. Distal stent migration causing duodenal perforation is an uncommon complication of this procedure and is usually delayed. Early stent migration resulting in duodenal perforation is extremely rare and can be easily overlooked. We present a case of stent migration and resultant intraperitoneal duodenal perforation that occurred 24 hours following plastic stent insertion for a malignant biliary stricture in a 63-year-old woman. The patient required emergent abdominal laparoscopy with the placement of intraperitoneal drain, followed by endoscopic extraction of the stent and closure of the defect using a through-the-scope clip. This case report addresses intraperitoneal duodenal perforation secondary to early migration of biliary stents. Special emphasis is placed on the importance of prompt diagnosis and the use of endoclips in the management of this serious complication of endoprosthesis.
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Affiliation(s)
- Khaled Jadallah
- Department of Internal Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Bara Alzubi
- Department of Internal Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Aroob Sweidan
- Department of Internal Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdel R Almanasra
- Department of General Surgery and Urology, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan
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12
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Kim SH, Moon JH, Lee YN, Lee TH, Woo SM, Lee WJ, Jang SI, Lee DK. Endoscopic management of duodenal perforations caused by migrated biliary plastic stents. Endosc Int Open 2019; 7:E792-E795. [PMID: 31198841 PMCID: PMC6561770 DOI: 10.1055/a-0887-4200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/16/2019] [Indexed: 01/15/2023] Open
Abstract
Background and study aims Duodenal perforation by migration of plastic stents placed to treat biliary lesions is rare but can be life-threatening. Surgical management is preferred, but it may increase risks of mortality and morbidity, especially in patients with underlying comorbidities and those of advanced age. We describe five cases of duodenal perforation that were successfully managed endoscopically. Four patients were elderly, and one had end-stage renal disease. We used cylindrically adapted cap-fitted endoscopy to successfully retrieve migrated plastic stents and to close the perforated walls with hemoclips. No post-procedural complication was noted. In conclusion, endoscopic management is appropriate as a first-line approach in patients with duodenal perforations caused by plastic stent migration.
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Affiliation(s)
- Shin Hee Kim
- Digestive Disease Center and Research Institutes, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Jong Ho Moon
- Digestive Disease Center and Research Institutes, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea,Corresponding author Jong Ho Moon, MD, PhD SoonChunHyang University School of MedicineDigestive Disease Center and Research InstituteSoonChunHyang University Bucheon Hospital170 Jomaru-ro, Wonmi-gu, Bucheon, 14584Korea+82-32-621-5080
| | - Yun Nah Lee
- Digestive Disease Center and Research Institutes, Department of Internal Medicine, SoonChunHyang University School of Medicine, Bucheon, Korea
| | - Tae Hoon Lee
- Digestive Disease Center and Research Institutes, Department of Internal Medicine, SoonChunHyang University School of Medicine, Cheonan, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, Hospital, National Cancer Center, Goyang, Korea
| | - Sung Il Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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13
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Bowles-Cintron RJ, Perez-Ginnari A, Martinez JM. Endoscopic management of surgical complications. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2018. [DOI: 10.1016/j.tgie.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Ferm S, Fisher C, Hassam A, Rubin M, Kim SH, Hussain SA. Primary Endoscopic Closure of Duodenal Perforation Secondary to Biliary Stent Migration: A Case Report and Review of the Literature. J Investig Med High Impact Case Rep 2018; 6:2324709618792031. [PMID: 30116760 PMCID: PMC6088461 DOI: 10.1177/2324709618792031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 06/23/2018] [Accepted: 07/04/2018] [Indexed: 12/23/2022] Open
Abstract
Duodenal perforation due to biliary stent migration is rare, and it often requires surgical repair; however, endoscopic closure has recently become a viable option in the appropriate patients. We present the case of a 79-year-old female who underwent biliary stent placement for a common bile duct stricture, who subsequently was found to have a duodenal wall perforation secondary to stent migration. The stent was extracted endoscopically with successful defect closure using a ConMed® repositional DuraClip™. We aim to contribute to the limited body of literature that describes endoscopic repair of duodenal perforation secondary to biliary stent migration using through-the-scope endoclips.
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Affiliation(s)
- Samson Ferm
- New York-Presbyterian Queens, Department of Internal Medicine; Flushing, NY, USA
| | - Constantine Fisher
- New York-Presbyterian Queens, Division of Gastroenterology; Flushing, NY, USA
| | - Akil Hassam
- New York-Presbyterian Queens, Division of Gastroenterology; Flushing, NY, USA
| | - Moshe Rubin
- New York-Presbyterian Queens, Division of Gastroenterology; Flushing, NY, USA
| | - Sang-Hoon Kim
- New York-Presbyterian Queens, Division of Gastroenterology; Flushing, NY, USA
| | - Syed Ahsan Hussain
- New York-Presbyterian Queens, Division of Gastroenterology; Flushing, NY, USA
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15
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Endoscopic treatment of iatrogenic gastrointestinal perforations: an overview. Dig Liver Dis 2014; 46:195-203. [PMID: 24210991 DOI: 10.1016/j.dld.2013.09.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 08/28/2013] [Accepted: 09/10/2013] [Indexed: 02/06/2023]
Abstract
In the past, the treatment of iatrogenic gastrointestinal perforations was limited to surgical management or to medical observation. Natural Orifice Transluminal Endoscopic Surgery (NOTES) has paved the way towards the development of reliable endoscopic closure techniques, which can be applicable in accidental perforations of the gastrointestinal tract. When endoscopic treatment is feasible, hemoclips are preferred in smaller perforations, while over-the-scope-clips or a combination of hemoclips, endoloops, and glue are used in larger ones. Endoscopic stitching is rarely utilized, and endoscopic stapling has been practically abandoned. The use of self-expandable covered stents can be considered in the esophagus and duodenum. Broad spectrum antibiotics are recommended in most cases. Clinical follow-up in a medico-surgical unit is mandatory and surgical intervention should not be delayed more than 24h if clinical or biological worsening occurs. Imaging with oral contrast medium is advisable before resumption of oral feeding in the case of large perforations.
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16
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Raju GS. Endoscopic clip closure of gastrointestinal perforations, fistulae, and leaks. Dig Endosc 2014; 26 Suppl 1:95-104. [PMID: 24373001 DOI: 10.1111/den.12191] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023]
Abstract
Development of endoscopic devices to close perforations has certainly revolutionized endoscopy. Immediate closure of perforations eliminates the need for surgery, which allows us to push the limits of endoscopic surgery from the mucosal plane to deep submucosal layers and eventually transmurally. The present article focuses on endoscopic closure devices, closure techniques, followed by a review of animal and clinical studies on endoscopic closure of perforations.
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Affiliation(s)
- Gottumukkala S Raju
- Department of Gastroenterology, Hepatology, and Nutrition, University of Texas MD Anderson Cancer Center, Houston, USA
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Saravanan MN, Mathai V, Kapoor D, Singh B. Fractured metallic biliary stent causing obstruction and jejunal perforation. Asian J Endosc Surg 2013; 6:234-6. [PMID: 23879419 DOI: 10.1111/ases.12033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 12/20/2022]
Abstract
Interventional internal drainage of the biliary tract has become an established procedure for both the temporary and definitive treatment of biliary obstruction due to malignant or benign disease. Biliary stent migration and stent fracture are known but rare complications. A 50-year-old man presented with acute onset pain in the abdomen and vomiting. He had undergone hepaticojejunostomy following a bile duct injury during open cholecystectomy 13 years before he presented at our institution. Subsequently, he developed a benign biliary stricture at the anastomotic site, which was stented transhepatically by a metallic stent. CT of his abdomen showed a fractured stent segment obstructing the jejunum with a localized perforation. Herein, we discuss his presentation and course of management, and review the factors influencing stent migration and fracture and the potential options for stent retrieval. The patient needed surgical intervention to retrieve the migrated fragment of metal stent and to resect the perforated jejunal segment. The role of endoscopic self-expanding metal stents for benign biliary disease remains controversial. A migrated stent that has become symptomatic should be removed endoscopically in early and accessible cases and surgically when endoscopic measures fail or when complicated by obstruction or perforation.
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18
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Iatrogenic duodenal perforation treated with endoscopic placement of metallic clips: a case report. Case Rep Med 2012; 2012:609750. [PMID: 22431936 PMCID: PMC3297480 DOI: 10.1155/2012/609750] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 11/05/2011] [Accepted: 11/23/2011] [Indexed: 12/16/2022] Open
Abstract
Perforation is one of the major complications encountered during endoscopic procedures. The standard of care for these complications is either surgical intervention or nonoperative medical approach with antibiotics and bowel rest with or without parenteral alimentation. Metallic clips, initially developed to secure hemostasis in bleeding, have been successfully used to close perforations in the gastrointestinal tract (GI) including the duodenum. This avoids perioperative morbidities associated with surgical intervention while limiting the leakage of intestinal contents and peritoneal contamination that is possible with medical management. We present a case of a patient with a lateral duodenal perforation during an endoscopic retrograde cholangiopancreatography (ERCP) which was successfully treated with immediate placement of metallic endoclips.
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Abstract
PURPOSE OF REVIEW Understanding the role of endoscopic closure techniques helps in expanding the endoscopist's role in the management of gastrointestinal neoplasia and explore new frontiers of minimally invasive endoluminal surgery. RECENT FINDINGS This article covers recent advances in endoscopic closure of various gastrointestinal perforations, with a special focus on devices, experimental evidence and clinical outcomes of endoscopic closure of gastrointestinal perforations. SUMMARY Endoscopic closure techniques help the endoscopist to walk on thin ice and save himself and the patient in the case of mishap.
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20
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Nam HS, Kim GH, Kim DU, Choi MK, Yi YS, Hwang JM, Kim S. [A case of duodenal perforation caused by biliary plastic stent treated with approximation using endoclip and detachable snare]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2011; 57:129-33. [PMID: 21350325 DOI: 10.4166/kjg.2011.57.2.129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Endoscopic retrograde biliary drainage (ERBD) is useful for the palliative decompression of biliary obstruction. However, the complications of ERBD include cholangitis, hemorrhage, acute pancreatitis, obstruction of the stent, and duodenal perforation. Pressure necrosis on the duodenal mucosa by the stent may contribute to perforation. Although duodenal perforation following ERBD is very rare compared to other complications, it can result in a fatal outcome. Recent reports describe nonsurgical treatment for small gastrointestinal perforation with localized peritonitis and suggest that endoclipping may be appropriate in the management of a well selected group of patients with iatrogenic perforation. We describe a case of duodenal perforation secondary to ERBD that was successfully treated with approximating using endoclip and detachable snare.
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Affiliation(s)
- Hyung Seok Nam
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
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21
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Jafferbhoy SF, Scriven P, Bannister J, Shiwani MH, Hurlstone P. Endoscopic management of migrated biliary stent causing sigmoid perforation. BMJ Case Rep 2011; 2011:bcr.04.2011.4078. [PMID: 22696699 DOI: 10.1136/bcr.04.2011.4078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Endoscopically deployed biliary stents are a well established method for dealing with biliary diseases. Perforation of the gut secondary to migrated biliary stent is reported in less than 1% cases. The authors present the first case of a colonic perforation from migrated biliary stent which was managed endoscopically. An 82-year-old female had a biliary stent for a postcholecystectomy bile leak and presented 6 months later with left iliac fossa pain. Barium enema showed a stent perforating the sigmoid colon. In view of the patient's frailty and absence of peritonitis, an endoscopic retrieval of stent was attempted. Flexible sigmoidoscopy showed a stent partially embedded within the sigmoid diverticulum which was successfully removed and the defect was closed endoscopically using three titanium clips. She had an uncomplicated recovery following the procedure and was discharged home on the second day following the procedure.
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Affiliation(s)
- Sadaf F Jafferbhoy
- Department of General Surgery, Barnsley District Hospital NHS Foundation Trust, Barnsley, UK.
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22
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Mangiavillano B, Viaggi P, Masci E. Endoscopic closure of acute iatrogenic perforations during diagnostic and therapeutic endoscopy in the gastrointestinal tract using metallic clips: a literature review. J Dig Dis 2010; 11:12-8. [PMID: 20132426 DOI: 10.1111/j.1751-2980.2009.00414.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Iatrogenic perforations that occur during the endoscopic procedures are generally surgically managed, even if some authors prefer a non-surgical approach in selected cases. The endoscopic application of metallic clips has been widely used in the gastrointestinal (GI) tract for hemostasis and also for marking lesions. Since 1993 several series of endoscopic perforations treated with endoclips have been described in the literature. In this review we offer a descriptive analysis of the reported cases of the acute iatrogenic perforation, describing the closure of different perforations occurring in the GI tract, treated with metallic clips.
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Affiliation(s)
- Benedetto Mangiavillano
- Department of Gastroenterology and Gastrointestinal Endoscopy, San Paolo University Hospital, Milan, Italy.
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23
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Hunter K, Siddiqui T, Komolafe O, Chong D. Colonic perforation secondary to migrated biliary stent. Case report of an unusual complication, and literature review. Scott Med J 2010. [DOI: 10.1258/rsmsmj.55.1.57i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Endoscopic stents are widely used to facilitate biliary drainage in hepatic, biliary and pancreatic conditions. Migration of the stent is a potentially serious complication. We report a case of migration of a biliary stent to the sigmoid colon at which point the stent perforated the colon and become lodged subcutaneously. The patient was managed successfully by local exploration to retrieve the stent without bowel resection. We also review the literature on complications caused by migrated biliary stents.
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Affiliation(s)
- K Hunter
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - T Siddiqui
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Oo Komolafe
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
| | - Dcs Chong
- Department of Surgery Stobhill Hospital Balornock Road Glasgow G21 3UW
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24
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Abstract
Surgery has been the mainstay of therapy in patients with gastrointestinal perforations. This paradigm started to shift with the development of techniques for endoscopic closure of gastrointestinal perforations. A detailed review of the literature on this subject, along with a commentary on practical aspects in the management of patients with gastrointestinal leaks, is provided here.
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25
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Culnan DM, Cicuto BJ, Singh H, Cherry RA. Percutaneous retrieval of a biliary stent after migration and ileal perforation. World J Emerg Surg 2009; 4:6. [PMID: 19183489 PMCID: PMC2642780 DOI: 10.1186/1749-7922-4-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Accepted: 01/31/2009] [Indexed: 02/07/2023] Open
Abstract
We present a case of a migrated biliary stent that resulted in a distal small bowel perforation, abscess formation and high grade partial small bowel obstruction in a medically stable patient without signs of sepsis or diffuse peritonitis. We performed a percutaneous drainage of the abscess followed by percutaneous retrieval of the stent. The entero-peritoneal fistula closed spontaneously with a drain in place. We conclude, migrated biliary stents associated with perforation distal to the Ligament of Trietz (LOT), may be treated by percutaneous drainage of the abscess and retrieval of the stent from the peritoneal cavity, even when associated with a large intra-abdominal abscess.
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Affiliation(s)
- Derek M Culnan
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Bryan J Cicuto
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Harjit Singh
- Department of Radiology, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
| | - Robert A Cherry
- Department of Surgery, The Pennsylvania State University, College of Medicine, M. S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
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26
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Lee TH, Park DH, Park JY, Lee SH, Chung IK, Kim HS, Park SH, Kim SJ. Aortoduodenal fistula and aortic aneurysm secondary to biliary stent-induced retroperitoneal perforation. World J Gastroenterol 2008; 14:3095-7. [PMID: 18494067 PMCID: PMC2712183 DOI: 10.3748/wjg.14.3095] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Duodenal perforations caused by biliary prostheses are not uncommon, and they are potentially life threatening and require immediate treatment. We describe an unusual case of aortic aneurysm and rupture which occurred after retroperitoneal aortoduodenal fistula formation as a rare complication caused by biliary metallic stent-related duodenal perforation. To our knowledge, this is the first report describing a lethal complication of a bleeding, aortoduodenal fistula and caused by biliary metallic stent-induced perforation.
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27
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Abstract
Endoscopic clips are relatively new devices that have been shown to be effective for the control of acute gastrointestinal hemorrhage. Various different models are available and offer simplicity of use with relatively few complications. Recently, endoscopic clips have been used for a variety of non-hemorrhagic conditions. In this article we review the literature and present current thinking about the indications, efficacy and safety of these devices.
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Affiliation(s)
- Michael J Grupka
- Department of Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
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28
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Abstract
The acute abdomen accounts for up to 40% of all emergency-surgical hospital admissions and is considered in the differential in the more than 7 million visits to the emergency department annually for abdominal pain in the United States. A large percentage of these cases are secondary to perforation or impending gastrointestinal perforation. Gastrointestinal perforation causes considerable mortality and usually requires emergency surgery.Rapid diagnosis and treatment of these conditions is essential to reduce the high morbidity and mortality of late-stage presentation. Successful treatment requires a thorough understanding of the anatomy, microbiology, and pathophysiology of this disease process and in-depth knowledge of the therapy, including resuscitation,antibiotics, source control, and physiologic support.
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Affiliation(s)
- John T Langell
- Department of Surgery, University of Utah, 30 North 1900 East, SOM 3B115, Salt Lake City, UT 84132, USA.
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29
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Small AJ, Petersen BT, Baron TH. Closure of a duodenal stent-induced perforation by endoscopic stent removal and covered self-expandable metal stent placement (with video). Gastrointest Endosc 2007; 66:1063-5. [PMID: 17767928 DOI: 10.1016/j.gie.2007.03.1082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2007] [Accepted: 03/29/2007] [Indexed: 12/10/2022]
Affiliation(s)
- Aaron J Small
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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30
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Ha JPY, Leung LH, Tang CN, Li MKW. Silent duodenocolic fistula secondary to biliary stent migration. SURGICAL PRACTICE 2007. [DOI: 10.1111/j.1744-1633.2007.00362.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Abstract
Endoscopic closure of gastrointestinal perforations, fistulas, and anastomotic dehiscence is technically feasible. Endoluminal closure of the instrumental perforations of the gastrointestinal tract can be accomplished immediately after the recognition of perforation, while avoiding the delay of arranging surgery and the trauma associated with thoracotomy or laparotomy. In addition, endoscopic closure should be considered in patients with anastomotic dehiscence and chronic fistulas as this may avoid the risk associated with reoperation. The outcome of closure depends on the technical expertise in the proper selection and use of various endoluminal closure options. Training of the endoscopists in the use of this novel technology will enhance the quality of care of our patients.
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Affiliation(s)
- G S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Internal Medicine, 4.106 McCullough Building, 301 University Boulevard, University of Texas Medical Branch, Galveston, TX 77555-0764, USA.
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32
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Chuttani R, Barkun A, Carpenter S, Chotiprasidhi P, Ginsberg GG, Hussain N, Liu J, Silverman W, Taitelbaum G, Petersen B. Endoscopic clip application devices. Gastrointest Endosc 2006; 63:746-50. [PMID: 16650531 DOI: 10.1016/j.gie.2006.02.042] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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33
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Lanteri R, Naso P, Rapisarda C, Santangelo M, Di Cataldo A, Licata A. Jejunal perforation for biliary stent dislocation. Am J Gastroenterol 2006; 101:908-9. [PMID: 16635240 DOI: 10.1111/j.1572-0241.2006.00509.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Seewald S, Soehendra N. Perforation: part and parcel of endoscopic resection? Gastrointest Endosc 2006; 63:602-5. [PMID: 16564859 DOI: 10.1016/j.gie.2005.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2005] [Accepted: 08/27/2005] [Indexed: 02/08/2023]
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35
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36
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Raju GS, Pham B, Xiao SY, Brining D, Ahmed I. A pilot study of endoscopic closure of colonic perforations with endoclips in a swine model. Gastrointest Endosc 2005; 62:791-5. [PMID: 16246701 DOI: 10.1016/j.gie.2005.07.047] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2005] [Accepted: 07/28/2005] [Indexed: 12/10/2022]
Abstract
BACKGROUND Surgical closure of a colon perforation is accompanied by the risks of general anesthesia and prolonged recovery from surgery because of ileus and other sequelae. Very little is known about the effectiveness of endoluminal repair of colon perforations with clips, which eliminates incisions of the abdominal wall and provides a less invasive alternative to surgical closure. The aim of this study is to evaluate the feasibility and the safety of endoscopic closure of colonic perforations with endoclips in a porcine model. METHODS Approximately 1.5- to 2-cm colon perforations created with a needle knife in 4 50-kg, female pigs that were under general anesthesia were closed with endoclips. After 24 hours of recovery, the animals were allowed to eat. All the animals received intravenous antibiotics and were carefully monitored for signs of sepsis. After a follow-up of 1 week, the pigs were euthanized for postmortem examination. The fifth pig was euthanized immediately after closure of a 5-cm colon perforation with clips to evaluate the extent of transmural closure with endoclips. RESULTS The animals recovered well, without any clinical features of sepsis or peritonitis. Postmortem examination did not reveal fecal peritonitis, and there was no evidence of pericolonic abscess formation at the site of perforation. The perforation site showed signs of healing without any evidence of transmural dehiscence. Histopathology demonstrated granulation tissue bridging the site of perforation. In the fifth pig, euthanized immediately after closure of the perforation, nice mucosal apposition was seen, while the muscular and serosal coats remained dehisced. CONCLUSIONS Endoscopic closure of small iatrogenic colon perforations with clips results in mucosal and submucosal healing and prevents fecal soiling of peritoneal cavity.
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Affiliation(s)
- Gottumukkala S Raju
- Center for Endoscopic Research, Training, and Innovation (CERTAIN), Department of Medicine, Surgery and Pathology, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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37
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Katsinelos P, Paroutoglou G, Papaziogas B, Beltsis A, Dimiropoulos S, Atmatzidis K. Treatment of a duodenal perforation secondary to an endoscopic sphincterotomy with clips. World J Gastroenterol 2005; 11:6232-4. [PMID: 16273659 PMCID: PMC4436649 DOI: 10.3748/wjg.v11.i39.6232] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Perforation is one of the most serious complications of endoscopic sphincterotomy (ES) necessitating immediate surgical intervention. We present a case of successful management of such a complication with endoclipping. A 85-year-old woman developed duodenal perforation after ES. The perforation was identified early and its closure was achieved using three metallic clips in a single session. There was no procedure-related morbidity or complications and our patient was discharged from hospital 10 d later. Endoclipping of duodenal perforation induced by ES is a safe, effective and alternative to surgery treatment.
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Affiliation(s)
- Panagiotis Katsinelos
- Department of Endoscopy and Motility Unit, "G.Gennimatas" Hospital, Ethnikis Aminis 41, 54635 Thessaloniki, Greece.
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38
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Sánchez-Tembleque MD, Naranjo Rodríguez A, Ruiz Morales R, Hervás Molina AJ, Calero Ayala B, de Dios Vega JF. [Duodenal perforation due to an endoscopic biliary prosthesis]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 28:225-7. [PMID: 15811264 DOI: 10.1157/13073091] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Endoscopic biliary drainage through endoscopic retrograde cholangiopancreatography (ERCP) is a widely accepted therapeutic option in malignant biliary obstructions. However, the procedure is not free of complications. Perforation is one possible complication although it is much less frequent (less than 1%) than pancreatitis (5.4%) or hemorrhage (2%). We present 2 cases of duodenal perforation after placement of a biliary prosthesis through ERCP. Both patients had extensive hilar cholangiocarcinoma. Onset of symptoms of perforation occurred a few hours after placement of the prosthesis and the diagnosis was confirmed by computed tomography and laparotomy. We believe that the mechanism through which perforation occurred was proximal adhesion of the prosthesis to the tumor. This increased the intensity of distal trauma produced by the intraduodenal segment, preventing adaptation of the prosthesis to intestinal peristalsis. A good preventive measure would consist of correctly adjusting the length of the prosthesis in relation to the proximal end of the biliary stenosis.
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Affiliation(s)
- M D Sánchez-Tembleque
- Unidad Clínica de Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain.
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39
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Charabaty-Pishvaian A, Al-Kawas F. Endoscopic treatment of duodenal perforation using a clipping device: case report and review of the literature. South Med J 2004; 97:190-3. [PMID: 14982273 DOI: 10.1097/01.smj.0000091031.77846.b6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The standard treatment for gastrointestinal perforation secondary to an endoscopic procedure is surgical repair. Some authors advocate a conservative medical management. However, this approach may be associated with increased morbidity and mortality. We describe a case of duodenal perforation secondary to snare polypectomy that was successfully treated with endoclipping. Additional published case reports were reviewed. Current data suggest that endoclipping may be appropriate in the management of a select group of patients with iatrogenic gastrointestinal perforation.
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40
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Affiliation(s)
- Gottumukkala S Raju
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas 77555-0764, USA
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41
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Abstract
Iatrogenic perforation of the gastrointestinal tract is a medical emergency and is inevitable. An endoscopist must maintain a high index of suspicion despite minimal or atypical symptoms and negative radiologic studies, because perforation is a complication with tremendous morbidity and mortality. The endoscopist must know how to manage this complication appropriately and to seek immediate surgical consultation. There is ongoing controversy about when a patient should undergo nonoperative or surgical therapy. An evidence-based approach to manage iatrogenic perforation is not possible. The trend in the modern era is to less invasive, nonoperative therapy, given advancements in ICU care and antibiotics. Laparoscopy or laparoscopic-assisted (minilaparotomy) surgery is also being increasingly used with outcomes comparable with conventional laparotomy. Experience and advancements in accessories have enabled endoscopic repair of iatrogenic perforation in many situations [84]. The management algorithms provided synthesize the pertinent literature into reasonable guidelines to follow. Ultimately, an individualized approach must be taken to manage the patient with an iatrogenic perforation.
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Affiliation(s)
- Rajesh V Putcha
- Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center at Dallas, Room F.4.310, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA
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42
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Baccarani U, Risaliti A, Sainz-Barriga M, Adani GL, Donini A, Toniutto P, Bresadola F. Ileosplenic fistula and splenic abscesses caused by migration of biliary stents in a liver transplant recipient. Gastrointest Endosc 2003; 58:811-3. [PMID: 14997896 DOI: 10.1016/s0016-5107(03)02112-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Umberto Baccarani
- Department of Surgery and Transplantation Unit, University Hospital Udine, Italy
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43
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Basile A, Macri' A, Lamberto S, Caloggero S, Versaci A, Famulari C. Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent. Gastrointest Endosc 2003; 57:136-8. [PMID: 12518156 DOI: 10.1067/mge.2003.37] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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44
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Cerisoli C, Diez J, Giménez M, Oria M, Pardo R, Pujato M. Implantation of migrated biliary stents in the digestive tract. HPB (Oxford) 2003; 5:180-2. [PMID: 18332981 PMCID: PMC2020584 DOI: 10.1080/13651820310015301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. CASE OUTLINES Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. DISCUSSION Biliary stents migrate in 8-10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.
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Affiliation(s)
- C Cerisoli
- Instituto del CallaoBuenos AiresArgentina
| | - J Diez
- Division of Gastrointestinal Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - M Giménez
- Department of Surgery, Hospital A RoffoBuenos AiresArgentina
| | - M Oria
- Department of General Surgery, Division of Laparoscopic Surgery, Hospital de Clinicas, University HospitalBuenos AiresArgentina
| | - R Pardo
- Salvador UniversityBuenos AiresArgentina
| | - M Pujato
- Instituto Argentino de Diagnostico y TratamientoArgentina
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45
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Matsushita M, Takakuwa H, Nishio A. Endoscopic removal techniques and clipping closure for chicken bones wedged transversely in the colon. Dis Colon Rectum 2001; 44:749-50. [PMID: 11357041 DOI: 10.1007/bf02234580] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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