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Li Y, Yu T, He H, Hou S, Zhang L. A novel peroral choledochoscope was used to remove a proximal displaced stent-stone complex. Endoscopy 2023; 55:E608-E610. [PMID: 37040885 PMCID: PMC10089800 DOI: 10.1055/a-2051-8199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Affiliation(s)
- Yaoting Li
- The Second Hospital of Hebei Medical University, Department of Biliopancreatic Endoscopic Surgery Shijiazhuang, Hebei, CN
| | - Tingting Yu
- The Second Hospital of Hebei Medical University, Department of Biliopancreatic Endoscopic Surgery Shijiazhuang, Hebei, CN
| | - Hongfei He
- The Second Hospital of Hebei Medical University, Department of Biliopancreatic Endoscopic Surgery Shijiazhuang, Hebei, CN
| | - Senlin Hou
- The Second Hospital of Hebei Medical University, Department of Biliopancreatic Endoscopic Surgery Shijiazhuang, Hebei, CN
| | - Lichao Zhang
- The Second Hospital of Hebei Medical University, Department of Biliopancreatic Endoscopic Surgery Shijiazhuang, Hebei, CN
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2
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Nguyen NT, Khan HA, Abdul-Baki K, Choi W, Shroff NK, Akhtar Z, Bhargava P. CT imaging features of bile duct stent complications. Clin Imaging 2023; 103:109986. [PMID: 37742411 DOI: 10.1016/j.clinimag.2023.109986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/29/2023] [Accepted: 09/15/2023] [Indexed: 09/26/2023]
Abstract
Biliary stents have been widely used to treat both malignant and benign biliary obstruction. Biliary stenting serves as a temporary measure to maintain ductal patency and promote bile drainage. Biliary decompression can help relieve clinical symptoms of pain, obstructive jaundice, pruritis, fat malabsorption, and failure to thrive and prevent disease progression, such as secondary biliary cirrhosis and end-stage liver failure. Endoscopic placement of biliary endoprosthesis is a minimally invasive procedure well tolerated by most patients but is not without problems. Multiple early and late complications have been reported in the literature and Computed Tomography (CT) is the most used modality to assess normal positions and evaluate patients suspected of stent complications. The aim of this article is to provide a review various of biliary stent related complications, as seen on CT. Current literature on risk factors, diagnosis and management is also discussed.
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Affiliation(s)
- Nga T Nguyen
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Hasan A Khan
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Kian Abdul-Baki
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Woongsoon Choi
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Neel K Shroff
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Zahra Akhtar
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America
| | - Peeyush Bhargava
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, United States of America.
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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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AlZoubi L, Badwan B, Fayyad A. Ileal perforation due to migrated biliary stent: A case report. Arab J Gastroenterol 2023; 24:180-182. [PMID: 37673707 DOI: 10.1016/j.ajg.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/29/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
Ileal perforation caused by the migration of a biliary stent is a rare complication that can occur during endoscopic stent placement for benign or malignant biliary tract diseases. The current study reports the case of a 45-year-old woman with a history of Endoscopic retrograde cholangiopancreatography (ERCP) in which a migrated biliary stent resulted in an ileal perforation.
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Affiliation(s)
- Lujain AlZoubi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | - Basem Badwan
- General Surgery, Al-Basheer Hospital, Amman, Jordan
| | - Ahmad Fayyad
- General Surgery, Al-Basheer Hospital, Amman, Jordan
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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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6
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Abstract
BACKGROUND AND PURPOSE The frequency, risk factors as well as the sites of biliary stent migration are variable in the literature. This retrospective study investigated the frequency of biliary stent migration, why biliary stents migrated, how the migrated stents affected the patients, and what are the different techniques retrieved the migrated stents. PATIENTS AND METHODS Out of 876 stented patients, 74 patients (8.4%) had their stents migrated. Patients with and without migrated stents were compared regarding endoscopy and stent-related parameters. The sequels of stent migrations were reported. Furthermore, the methods used for stent retrieval were reviewed. RESULTS Proximal and distal stent migration occurred at a rate of 3 and 5.5%, respectively. The independent predictors for stent migration were moderate to marked common bile duct (CBD) dilation, complete sphincterotomy, the use of balloon dilation, and stent insertion for more than 1 month. Cholangitis and stent obstruction was the most commonly reported adverse event (n = 18, 24.3%). Distal stent migration associated with two cases of bleeding due to duodenal wall injury, and two cases of duodenal perforation. All the retained migrated stents in the current study were retrieved by endoscopy using extraction balloon, Dormia basket, snares, and foreign body forceps. CONCLUSION Biliary stent migration occurs at a rate of 8.4%. Stents do migrate because of dilated CBD, wide sphincterotomy, and biliary balloon dilation. Furthermore, wide, straight stents inserted for more than 1 month easily migrate. The migrated stents migrated intraluminal in the CBD, duodenum or the colon. All the retained migrated stents were retrieved endoscopically.
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Affiliation(s)
- Mohamed H Emara
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Mohammed Hussien Ahmed
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
| | - Ahmed S Mohammed
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed I Radwan
- Tropical Medicine Department, faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Aya M Mahros
- Hepatology, Gastroenterology and Infectious Diseases Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh
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Ozair A, Ahmad F, Kumar S, Rungta S. Transhepatic intraperitoneally migrated biliary stent: A rare finding during laparoscopic cholecystectomy. J Minim Access Surg 2021; 17:85-87. [PMID: 33353893 PMCID: PMC7945635 DOI: 10.4103/jmas.jmas_32_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Biliary endoprostheses are increasingly being utilised across both the developing and developed world, due to growing access to endoscopic biliary stenting. Stent migration, a well-documented complication of this minimally invasive procedure, occurs in up to 10% of cases post-insertion, sometimes leading to catastrophic complications. While distal migration frequently leads to spontaneous passage of the stent, proximal migration can result in a variety of problems. We here describe a rare case of transhepatic intraperitoneal migration of a double-pigtail, plastic stent and present a comprehensive review of literature.
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Affiliation(s)
- Ahmad Ozair
- Department of General Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Faraz Ahmad
- Department of General Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surender Kumar
- Department of General Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sumit Rungta
- Department of General Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
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8
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Siaperas P, Ioannidis A, Skarpas A, Angelopoulos A, Drikos I, Karanikas I. A rare cause for Hartmann's procedure due to biliary stent migration: A case report. Int J Surg Case Rep 2017; 31:83-85. [PMID: 28122319 PMCID: PMC5257179 DOI: 10.1016/j.ijscr.2017.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/08/2017] [Accepted: 01/08/2017] [Indexed: 12/12/2022] Open
Abstract
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.
Introduction Biliary stent migration (proximal or distal) occurs in 6% of all cases. The majority of these migrating stents are passing through the intestine, without causing any complications. Usually when a stent migration occurs, endoscopic retrieval is the proper treatment option, except in case of complications when surgical removal is the only treatment option. This report presents a case of a biliary stent which migrated and caused a sigmoid colon perforation. Presentation of case A 75 years old female patient presented to the emergency department with diffuse abdominal pain, nausea and vomiting. Clinical examination showed distended abdomen and signs of peritoneal irritation. CT scan of the abdomen revealed free gas and fluid in the left iliac fossa, as well as a foreign body penetrating the sigmoid colon. Emergency laparotomy was performed. A plastic stent was found perforating the sigmoid colon through a diverticulum. The rest of the sigmoid colon was intact presenting only uncomplicated diverticula. Hartmann’s operation was performed, involving the diseased segment, together with part of the descending colon due to profound diverticulosis. Patient’s post-surgical course was uneventful and was discharged on postoperative day 10. Discussion Migration of a biliary stent can cause life-threatening complications such as perforation of the intestine and peritonitis. The migration of the stent from the biliary tree may be mostly asymptomatic except in cases of intestinal perforation that immediate surgery is the proper treatment option. On the other hand, even in cases of benign lesions of the bile duct, the stent should be removed immediately after dislocation in order to reduce the risk of secondary complications such as obstruction, infection or perforation. Conclusion In cases of non-complicated stent migration endoscopic retrieval is the indicated treatment. In patients who suffer serious complications due to stent dislocation, emergency surgery may be the proper treatment option.
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Affiliation(s)
- Petros Siaperas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Argyrios Ioannidis
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Andreas Skarpas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Argiris Angelopoulos
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Ioannis Drikos
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
| | - Ioannis Karanikas
- Department of Surgery, Sismanoglion General Hospital, Sismanoglou 1-P.O. BOX 15126, Athens, Greece.
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A Rare Complication of Biliary Stent Migration: Small Bowel Perforation in a Patient with Incisional Hernia. Case Rep Surg 2015; 2015:860286. [PMID: 26273488 PMCID: PMC4529966 DOI: 10.1155/2015/860286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 07/08/2015] [Accepted: 07/09/2015] [Indexed: 02/06/2023] Open
Abstract
Endoscopic biliary stents have been recently applied with increasing frequency as a palliative and curable method in several benign and malignant diseases. As a reminder, although most of the migrated stents pass through the intestinal tract without symptoms, a small portion can lead to complications. Herein, we present a case of intestinal perforation caused by a biliary stent in the hernia of a patient with a rarely encountered incarcerated incisional hernia.
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10
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Mady RF, Niaz OS, Assal MM. Migrated biliary stent causing perforation of sigmoid colon and pelvic abscess. BMJ Case Rep 2015; 2015:bcr2014206805. [PMID: 25870211 PMCID: PMC4401935 DOI: 10.1136/bcr-2014-206805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 01/30/2023] Open
Abstract
Endoscopically placed biliary stents are a well-established procedure for the treatment of benign and malignant causes of obstructive jaundice. A plastic stent is usually inserted in patients with obstructive jaundice due to pancreatic cancer as a short-term procedure. Stent migration has been reported as a complication, although in most cases the stent will pass through or remain in the bowel lumen for a period of time. In rare cases, the stent may cause sigmoid perforation and pelvic abscess formation, especially in patients with sigmoid diverticulae or abdominal adhesions due to previous surgery. We present a patient with sigmoid perforation and pelvic abscess due to distal migration of a biliary stent placed to decompress a pancreatic head carcinoma.
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11
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Strode MA, Bandera BC, Deveaux P, Rice RD. Migrated Biliary Stent Complicated by Small Bowel Obstruction. Am Surg 2013. [DOI: 10.1177/000313481307900704] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Matthew A. Strode
- Department of Surgery Eisenhower Army Medical Center Fort Gordon, Georgia
| | - Bradley C. Bandera
- Department of Surgery Eisenhower Army Medical Center Fort Gordon, Georgia
| | - Peter Deveaux
- Department of Surgery Womack Army Medical Center Fort Bragg, North Carolina
| | - Robert D. Rice
- Department of Surgery Eisenhower Army Medical Center Fort Gordon, Georgia
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12
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Tolan HK, Sriprayoon T, Akaraviputh T. Unusual penetration of plastic biliary stent in a large ampullary carcinoma: A case report. World J Gastrointest Endosc 2012; 4:266-8. [PMID: 22720129 PMCID: PMC3377870 DOI: 10.4253/wjge.v4.i6.266] [Citation(s) in RCA: 4] [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: 10/16/2011] [Revised: 04/13/2012] [Accepted: 04/27/2012] [Indexed: 02/05/2023] Open
Abstract
Endoscopic biliary stenting is a well-established treatment of choice for many obstructive biliary disorders. Commonly used plastic endoprostheses have a higher risk of clogging and dislocation. Distal stent migration is an infrequent complication. Duodenum is the most common site of a migrated biliary stent. Intestinal perforation can occur during the initial insertion or endoscopic or percutaneous manipulation, or as a late consequence of stent placement. A 52-year-old male who presented with obstructive jaundice underwent endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement. However, jaundice did not improve and he then underwent ERCP which revealed the plastic stent penetrating the ampullary tumor into the duodenal wall causing malfunction of the stent. A new plastic stent was inserted and the patient underwent Whipple’s operation. He is currently doing well after the operation.
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Affiliation(s)
- H Kerem Tolan
- H Kerem Tolan, Tassanee Sriprayoon, Thawatchai Akaraviputh, Department of Surgery, Division of General Surgery, Minimally Invasive Surgery Unit, Siriraj Gastrointestinal Endoscopy Center, Mahidol University, Bangkok 10700, Thailand
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13
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Cheon YK, Oh HC, Cho YD, Lee TY, Shim CS. New 10F soft and pliable polyurethane stents decrease the migration rate compared with conventional 10F polyethylene stents in hilar biliary obstruction: results of a pilot study. Gastrointest Endosc 2012; 75:790-7. [PMID: 22301338 DOI: 10.1016/j.gie.2011.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 11/09/2011] [Indexed: 02/08/2023]
Abstract
BACKGROUND Migration of biliary stents is a well-documented problem that can result in a variety of complications. The newly designed polyurethane (PU) stent, which is made of a soft and pliable material, may prevent distal and proximal stent migration. OBJECTIVE To compare the migration rate of the PU stent with that of the conventional polyethylene stent (PE). DESIGN Prospective, comparative, randomized trial. SETTING Tertiary academic medical centers. PATIENTS Fifty patients with a hilar stricture who had not undergone a previous drainage procedure. INTERVENTION In patients with hilar stricture, random assignment of either a PU stent or PE stent. MAIN OUTCOME MEASUREMENT The rate of early proximal or distal migration before stent occlusion. RESULTS Overall and distal migration rates were significantly lower in the PU group than in the PE group (4.5% vs 29%, P = .032 and 4.5% vs 26.1%, P = .049, respectively). There was no significant difference between the migration rate in benign and malignant biliary strictures (5.9% vs 21.4%, P = .167). Sex, stent length, preprocedure bilirubin level, and Bismuth type were not associated with migration rate in either the PU or PE group. Median stent patency was 148 days (range 36-224 days) in the PU group and 151 days (range 40-241 days) in the PE group (P = .891). LIMITATIONS Small sample size. CONCLUSIONS Use of the new PU stent, which is soft and pliable, decreased distal migration. The PU stent patency rates appear similar, but this study is not powered to demonstrate equivalency of patency.
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Affiliation(s)
- Young Koog Cheon
- Digestive Disease Center, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
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Uzzaman MM, Nair MS, Myint F. An unusual complication encountered incidentally at laparoscopic cholecystectomy: a case series. J Gastrointest Surg 2010; 14:1608-12. [PMID: 20652438 DOI: 10.1007/s11605-010-1238-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 05/25/2010] [Indexed: 01/31/2023]
Abstract
INTRODUCTION This is a case series of erosion of the common bile duct by an in situ stent found incidentally during laparoscopic cholecystectomy (LC). To the best of our knowledge, this is one of the first reported incidences of this nature. METHOD Four individual case reports. RESULTS Thirty nine patients with an in situ CBD stent underwent LC for symptomatic gallstones in our institution over a 4-year time period (2005 to 2009). Four patients were found to have the stent eroding through the wall of the CBD. In these four patients, endoscopic retrograde cholangiopancreatography (ERCP) had previously been performed - extracting stone(s) - followed by sphincterotomy and insertion of a 7 Fr pigtail stent (measuring 4 cm). The operation was converted to open in two patients, and the procedure was abandoned in one of these cases. In the other two patients, the anatomy of Calots triangle was delineated well, and the operator was able to complete LC. The duration between initial pigtail stent insertion and LC ranged from 32 to 400 days. None of our patients required a definitive surgical repair of the CBD or T-tube placement. The stent was removed during surgery in one case, removed endoscopically at a later date in two patients, and passed spontaneously in one patient. All four patients made a good postoperative recovery. CONCLUSION CBD erosion is a complication of plastic biliary stent insertion. CBD stent erosion will make surgery more hazardous especially if it remains in situ for a significant period of time. CBD erosion can generally be managed conservatively without the need for surgical repair. Awareness of this complication should prompt earlier surgery or earlier removal of plastic pigtail stents.
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Affiliation(s)
- Mohammed Mohsin Uzzaman
- Department of General Surgery, North Middlesex University Hospital, 62 Kensington Avenue, London E12 6NP, UK.
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15
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Bagul A, Pollard C, Dennison AR. A review of problems following insertion of biliary stents illustrated by an unusual complication. Ann R Coll Surg Engl 2010; 92:W27-31. [PMID: 20501006 DOI: 10.1308/147870810x12659688852239] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION 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. METHODS 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. FINDINGS 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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Affiliation(s)
- Atul Bagul
- HPB Department, University Hospitals of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
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16
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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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Migration of plastic biliary stents and endoscopic retrieval: an experience of three referral centers. Surg Laparosc Endosc Percutan Tech 2009; 19:217-21. [PMID: 19542849 DOI: 10.1097/sle.0b013e3181a031f5] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Proximal or distal migration of a plastic biliary stent is uncommon, but its management can be a technical challenge to the pancreatobiliary endoscopist. PATIENTS AND METHODS All cases (n=51) of proximally and distally migrated plastic biliary stents over an 8-year period at 3 referral pancreaticobiliary centers were included in this retrospective study. Indications for stenting, risk factors for migration, presentation of migration, and various techniques used for stent's retrieval are herein analyzed. RESULTS Twenty-one proximal and 30 distal bile duct-migrated stents were identified. All patients with proximally and 17 (56.7%) with distally migrated stents were symptomatic. Choledocholithiasis, dilated common bile duct, short and large size stent were the main risk factors. The retrieval of proximally migrated stents was successful in 15 patients (71.4%) and in all symptomatic patients with distal migration. The retrieval techniques included forceps, Dormia basket, snare, Soehendra stent retriever, and balloon. One patient died of sepsis due to peritonitis from duodenal perforation from a distally migrated stent. CONCLUSIONS Retrieval of a proximally migrated stent requires experience with different endoscopic devices. Moreover, distal migration needs attention because it can cause severe complications.
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18
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Namdar T, Raffel AM, Topp SA, Namdar L, Alldinger I, Schmitt M, Knoefel WT, Eisenberger CF. Complications and treatment of migrated biliary endoprostheses: A review of the literature. World J Gastroenterol 2007; 13:5397-9. [PMID: 17879415 PMCID: PMC4171335 DOI: 10.3748/wjg.v13.i40.5397] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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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Affiliation(s)
- Thomas Namdar
- Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Moorenstrasse 5, Dusseldorf 40225, Germany.
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Losanoff JE, Vanha TG, Testa G, Ahmed EB, Millis JM. Endoscopic biliary stent migration to the iliopsoas muscle in a liver transplant recipient: percutaneous removal. Dig Dis Sci 2007; 52:2508-11. [PMID: 17436093 DOI: 10.1007/s10620-006-9725-9] [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] [Received: 04/21/2006] [Accepted: 12/03/2006] [Indexed: 01/14/2023]
Affiliation(s)
- Julian E Losanoff
- Department of Surgery, Section of Transplantation, MC 5026, Room J 517, University of Chicago, 5841 South Maryland Avenue Chicago, Illinois 60637, USA.
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Diller R, Senninger N, Kautz G, Tübergen D. Stent migration necessitating surgical intervention. Surg Endosc 2003. [PMID: 14508668 DOI: 10.1007/s00464-002-9163-5.] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Internal drainage with transhepatically or endoscopically placed endoprostheses has been used for many years as a temporary or definitive treatment for biliary tract obstruction. As a late complication, stent migration may occur. METHODS We reviewed our records to identify patients who were operated on for a migrated endoprosthesis that was causing complications. In all, five such patients were identified. RESULTS One patient had a large bowel perforation. Bowel penetration led to an interenteric fistula in one patient and to a biliocolic fistula formation in another. Small bowel distension was found in two patients. Surgical treatment consisted of local excision in three patients, segmental resection in one patient, and a bypass operation in the patient with biliocolic fistula. Postoperatively, four patients recovered without problems, but one patient died during a complicated postoperative course. CONCLUSION If a stent becomes stuck in the gastrointestinal tract and is not accessible for endoscopic removal, early operative revision is mandatory to prevent further complications.
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Affiliation(s)
- R Diller
- Department of General Surgery, University Clinic of Muenster, Waldeyerstrasse 1, D-48149 Münster, Germany.
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Mahadeva S, Ranjeev P, Goh KL. Hepaticogastric fistulation from a proximally migrated biliary stent. Gastrointest Endosc 2003; 58:295-7. [PMID: 12872109 DOI: 10.1067/mge.2003.355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Sanjiv Mahadeva
- Division of Gastroenterology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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