title: Proximal migration of a 3 French pancreatic stent in a patient with pancreas divisum: suggested technique for successful retrieval.
abstract: BACKGROUND
  Pancreatic stents may be placed during therapeutic ERCP for a variety of indications. One such indication is to prophylax against the development of pancreatitis following sphincterotomy of the minor papilla in patients with recurrent acute pancreatitis and pancreas divisum. Increasingly, endoscopists that perform pancreatic ERCP are placing small caliber (3 Fr), unflanged, single pigtail stents into the long axis of the pancreatic duct with the expectation that these stents will only stay in place for a few days and the majority will pass spontaneously on their own without the need for follow-up endoscopic retrieval. As such, these stents are generally regarded as safer and associated with a lower rare of complication than larger (5 and 7 Fr), double flanged pancreatic stents.
  
  
  METHODS
  We present the case of a 3 Fr stent that migrated proximally into the dorsal duct in a patient with recurrent pancreatitis and pancreas divisum. Due to the small size of the patient's dorsal duct, it was difficult to pass appliances alongside the stent to facilitate retrieval and a variety of appliances were used before success was achieved.
  
  
  CONCLUSIONS
  The medical literature contains series of proximally migrated larger caliber flanged, pancreatic stents but proximal migration of small caliber, unflanged, pigtail stents has not yet been reported. As the use of these small stents increases, we feel that it is important to highlight the potential for this complication and discuss how we successfully treated our patient.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA. john.horwhat@na.amedd.army.mil
authors.forename: John David
authors.initials: JD
authors.lastname: Horwhat
authors.forename: Paul
authors.initials: P
authors.lastname: Jowell
authors.forename: Stanley
authors.initials: S
authors.lastname: Branch
authors.forename: Leonie
authors.initials: L
authors.lastname: Fleishman
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
mesh_terms: D000208:Acute Disease; D000328:Adult; D002404:Catheterization / Q000379:methods; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016145:Endoscopy, Digestive System; D005500:Follow-Up Studies; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000601:surgery*; D010195:Pancreatitis / Q000175:diagnosis / Q000601:surgery; D012307:Risk Factors; D016717:Sphincterotomy, Endoscopic / Q000295:instrumentation; D015607:Stents