Bilio-Cecal Stent Migration Presenting as Massive Rectal Bleeding

Abstract

Endoscopic biliary stenting is a well-established intervention for the treatment of biliary, hepatic, and pancreatic disorders. The common indications include strictures, neoplasms, stones, infections, and bile leaks. Stents can be occluded, predisposing patients to ascending cholangitis and biliary sepsis. Distal stent migration is another known complication of endoscopic stenting and is usually spontaneous. Bowel perforation, abscesses, bleeding, and pancreatitis are rare complications of distal stent migration and are usually limited to the duodenum. Herein, we describe an extremely rare case of bilio-cecal stent migration presenting as rectal bleeding.

Keywords: Biliary stent migration; Cecal impaction; Endoscopic stenting; Epigastric pain; Rectal bleeding.

Figure 1

Endoscopic retrograde cholangiopancreatography images showing a filling defect in the biliary duct, sphincterotomy, and stent placement. (a) Image showing a short 0.035-inch soft Jagwire being passed into the biliary tree. (b) Endoscopic image showing a cannulating sphincterotome being inserted into the biliary tree. (c) Image showing a one 4-Fr 5-cm plastic stent with a single external flap and no internal flaps being placed into the common bile duct (CBD)/ventral pancreatic duct (PD). (d) CBD wire. (e) PD w/cutoff a level of genu. (f-h) CBD wire. Yellow arrows in (d-f) show a filling defect consistent with a stone in genu of the pancreas. Yellow arrows in (f) and (h) show a filling defect consistent with a stone as seen on the cholangiogram. w/cutoff: with cutoff.

Figure 2

Endoscopic image showing a migrated stent impacted in the cecum and extending into the ascending colon. (a) Cecum. (b) Ascending colon. (c) Sigmoid colon. (d) Rectum. Red arrows (a) and (b) show a migrated stent impacted in the cecum.