[Abdominal pain following placement of an endoprosthesis in the biliary duct].
A 76-year-old man presented with diffuse progressive abdominal pain. He had undergone endoscopic retrograde pancreaticocholangiography (ERCP) 5 weeks earlier for jaundice and increased levels of liver enzymes. A dilated biliary duct with multiple concrements had been seen, and a plastic endoprosthesis was placed. During a follow-up ERCP the stent was not found, and the obstruction was still present. Another stent was placed. Abdominal x-ray revealed migration of the first endoprosthesis to the distal jejunum and signs of ileus and free gas. CT showed that the stent was stuck in a perforated diverticulum of the sigmoid, surrounded by an abscess mass. The stent was removed by laparotomy, the perforation was closed, and a double-loop stoma was made. Two weeks after initial recovery, abdominal pain recurred. CT revealed a second dislocated stent with a perforation of the jejunum. Laparotomy was performed again with removal of the stent and repair of the perforation. Migration is a known complication of biliary endoprosthesis placement, and should be considered in cases of abdominal pain after ERCP. Perforations rarely occur and mostly affect areas of the bowel that are fixed or that present obstacles to normal elimination. Two perforations within a short period of time is an extremely rare complication of migration.
Ruinemans
G M F
GM
Afd. Interne Geneeskunde, Twenteborg Ziekenhuis, Postbus 7600, 7600 SZ Almelo.
van Zanten
R A A
RA
Rakic
S
S
van den Hout
J H W
JH
Veneman
Th F
TF
D015746:Abdominal Pain / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000208:Acute Disease; D000368:Aged; D001652:Bile Ducts / Q000601:surgery*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005548:Foreign-Body Migration / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D008297:Male; D011183:Postoperative Complications; D019919:Prosthesis Implantation; D015607:Stents