An unusual complication encountered incidentally at laparoscopic cholecystectomy: a case series.
BACKGROUND
This is a case series of erosion of the common bile duct by an in situ stent found incidentally during laparoscopic cholecystectomy (LC). To the best of our knowledge, this is one of the first reported incidences of this nature.


METHODS
Four individual case reports.


RESULTS
Thirty nine patients with an in situ CBD stent underwent LC for symptomatic gallstones in our institution over a 4-year time period (2005 to 2009). Four patients were found to have the stent eroding through the wall of the CBD. In these four patients, endoscopic retrograde cholangiopancreatography (ERCP) had previously been performed - extracting stone(s) - followed by sphincterotomy and insertion of a 7 Fr pigtail stent (measuring 4 cm). The operation was converted to open in two patients, and the procedure was abandoned in one of these cases. In the other two patients, the anatomy of Calots triangle was delineated well, and the operator was able to complete LC. The duration between initial pigtail stent insertion and LC ranged from 32 to 400 days. None of our patients required a definitive surgical repair of the CBD or T-tube placement. The stent was removed during surgery in one case, removed endoscopically at a later date in two patients, and passed spontaneously in one patient. All four patients made a good postoperative recovery.


CONCLUSIONS
CBD erosion is a complication of plastic biliary stent insertion. CBD stent erosion will make surgery more hazardous especially if it remains in situ for a significant period of time. CBD erosion can generally be managed conservatively without the need for surgical repair. Awareness of this complication should prompt earlier surgery or earlier removal of plastic pigtail stents.
Uzzaman
Mohammed Mohsin
MM
Department of General Surgery, North Middlesex University Hospital, 62 Kensington Avenue, London E12 6NP, UK. mohsinuzzaman@yahoo.co.uk
Nair
Manojkumar S
MS
Myint
Fiona
F
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D017081:Cholecystectomy, Laparoscopic; D003135:Common Bile Duct / Q000293:injuries*; D003137:Common Bile Duct Diseases / Q000209:etiology*; D005260:Female; D042882:Gallstones / Q000601:surgery* / Q000628:therapy; D006801:Humans; D033162:Incidental Findings; D008875:Middle Aged; D016717:Sphincterotomy, Endoscopic; D015607:Stents / Q000009:adverse effects*