Unusual breakage of a plastic biliary endoprosthesis causing an enterocutaneous fistula.
OBJECTIVE
The objective of our study was to illustrate a case of endoscopically placed biliary stent breakage.


METHODS
A72-year-old woman with a prolonged history of cholangitis following laparoscopic cholecistectomy was referred to our institution 8 years ago. Dilatation of the intra- and extrahepatic biliary tree and a benign stricture at the cystic confluence were observed at US and endoscopic retrograde cholangiopancreatography (ERCP). A 12-F gauge plastic endoprosthesis was placed. In the absence of any symptoms, breakage of the stent was revealed 18 months later at plain radiology. Eight years later an enterocutaneous fistula occurred originating from a jejunal loop containing the indwelled distal part of the stent. Surgery was undertaken and the distal part of the stent removed with the perforated jejunal loop. The proximal part was successively endoscopically removed.


CONCLUSIONS
Disruption of a biliary endoprosthesis is observed in patients in whom the stent is kept in situ for a long period or consequent to exchange. The removal and exchange is mandatory when the stent disruption is followed by cholangitis. In the current case, because of the absence of any symptoms the removal of the stent was not attempted. Immediate endoscopic removal of the prosthetic fragments seems to be the treatment of choice for replacement of a new stent.
Fiori
E
E
Medical School, I Department of Surgery, University of Rome, "La Sapienza" 00191 Rome, Italy. enricofiori@tin.it
Mazzoni
G
G
Galati
G
G
Lutzu
S E
SE
Cesare
A
A
Bononi
M
M
Bolognese
A
A
Tocchi
A
A
D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects / Q000379:methods; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery*; D020878:Device Removal / Q000379:methods; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D005260:Female; D005548:Foreign-Body Migration / Q000150:complications / Q000601:surgery*; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D007583:Jejunum / Q000473:pathology / Q000601:surgery; D010969:Plastics / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D019736:Prostheses and Implants / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects
D010969:Plastics