Biliary stent causing colovaginal fistula: case report

Abstract

Objectives: Perforation of the bowel during placement of a biliary stent is a known complication of this procedure. We report the endoluminal loss of a biliary stent during routine stent extraction that ultimately led to a chronic colovaginal fistula. This case emphasizes the need for evaluation of fecal passage of stents in patients with a known dislodged prosthesis.

Case report: A 65-year-old white female underwent biliary stent placement for an episode of choledocholithiasis. The stent was lost in the duodenum during routine extraction. The patient was managed expectantly. She denied ever passing this stent via the rectum and began to develop symptoms of colovaginal fistula. Evaluation found a retained biliary stent in the sigmoid colon and a fistula into the vagina. The patient underwent elective low anterior resection and colovaginal fistula repair.

Discussion: Reports exist of migration of stents that lead to acute colonic perforation and the need for emergent surgery. For this reason, it has been suggested that dropped or migrated stents be purposefully retrieved. However, if the option of expectant observation is used, it is important to clearly document the fecal passage of these stents and be prepared to retrieve these objects if they have a prolonged bowel transit time.

Figure 1.

Plain KUB film revealing biliary stent prosthesis lodged in the pelvis.

Figure 2.

Colonoscopic view of sigmoid colon with diverticuli (D) and a stent (S) perforating a diverticulum leading to a fistula tract (F).

Figure 3.

Barium enema demonstrating a low sigmoid colovaginal fistula (F) with the presence of a biliary stent (B).