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Review
. 2020 May 12;20(1):149.
doi: 10.1186/s12876-020-01294-z.

Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Xiaopeng Wang  1 , Junwen Qu  1 , Kewei Li  2
Affiliations
Review

Duodenal perforations secondary to a migrated biliary plastic stent successfully treated by endoscope: case-report and review of the literature

Xiaopeng Wang et al. BMC Gastroenterol. .

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.

Keywords: Biliary stent; Case report; Duodenal perforation; Endoscope; Migration.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Duodenal perforation due to biliary plastic migration successfully managed by endoscope. a and b Coronal CT scan of the abdomen demonstrated that the biliary plastic stent (red arrow) had migrated and perforated through the duodenal wall. c Distal tip of biliary stent (black arrow) penetrated the duodenal wall which was confirmed during endoscope. d The migrated plastic stent was extracted by snare and perforation was detected during endoscopy. e The defect was successfully closed by hemostatic clips (blue arrow). f An endoscopic nasobiliary drainage (ENBD) tube (yellow arrow) was then inserted
See this image and copyright information in PMC

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