title: Fracture of an expandable metallic stent placed for biliary obstruction due to common bile duct carcinoma.
abstract: We report our second case of fracture of a SMART self-expandable metallic stent (Cordis Endovascular, Warren, NJ) placed to treat biliary obstruction due to an unresectable common bile duct carcinoma. An 82-year-old man presented with jaundice. Computed tomography and ultrasonography on admission demonstrated a mass in the lower common bile duct. The mass was identified as a common bile duct obstruction. A SMART stent was inserted. Ten months after stent insertion, two additional SMART stents were inserted to relieve obstructive jaundice due to occlusion of the first stent. Fourteen months after insertion of the first stent, endoscopic examination revealed stenosis of the duodenum due to invasion of the common bile duct carcinoma, prompting us to perform a gastrojejunostomy 1 month later. Three months after gastrojejunostomy, the patient presented with obstructive jaundice and cholangitis. A fracture of one of the stents was then discovered on plain X-ray films and percutaneous transhepatic cholangiography. Two SMART stents were inserted simultaneously. In conclusion, we report the fracture of a SMART stent placed for common bile duct carcinoma. Fracture should be considered as a possible complication after metallic stent insertion.
authors.affiliation: Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine, Tokyo, Japan. hiroshiy@nms.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Shimizu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Aimoto
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Nakamura
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nomura
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yokomuro
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Arima
authors.forename: Eiji
authors.initials: E
authors.lastname: Uchida
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Misawa
authors.forename: Eiichi
authors.initials: E
authors.lastname: Uchida
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000150:complications*; D002277:Carcinoma / Q000150:complications*; D002779:Cholestasis / Q000628:therapy*; D003135:Common Bile Duct; D006801:Humans; D008297:Male; D008670:Metals; D011475:Prosthesis Failure; D015607:Stents / Q000009:adverse effects*
chemical_list: D008670:Metals