Perforation Due to Biliary Stent: Case Report and Review

Endoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.