title: Perforation and abscess formation after radiological placement of a retrievable plastic biliary stent.
abstract: BACKGROUND
  Retrievable plastic biliary stents are usually inserted endoscopically. When endoscopic placement fails, radiological percutaneous transhepatic placement is indicated. We report the occurrence of a case of delayed duodenal perforation with abscess formation after radiological placement of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting.
  
  
  METHODS
  A 58-year-old Caucasian man had a mass 30 mm in size in the head of the pancreas and obstructive jaundice. He was referred for radiological insertion of plastic biliary stents after a failed endoscopic attempt. The procedure was uneventful, and the patient was discharged. Two weeks after the procedure, the patient presented with an acute abdomen and signs of sepsis. Computed tomography revealed erosion of the posterior duodenal wall from the plastic stent, and a large retroperitoneal abscess. The abscess was drained under computed tomography guidance, and the migrated stent was removed percutaneously with a snare under fluoroscopic guidance. Our patient had an uneventful recovery and was discharged after a week.
  
  
  CONCLUSIONS
  Late retroperitoneal duodenal perforation is a very rare but severe complication of biliary stenting with plastic stents. Gastroenterologists, surgeons and radiologists should all be aware of its existence, clinical presentation and management.
authors.affiliation: Department of Diagnostic Imaging, Barts and The London NHS Trust, The Royal London Hospital, London, E1 1BB, UK. fotiadis.nicholas@gmail.com.
authors.forename: Ioanna
authors.initials: I
authors.lastname: Papadopoulou
authors.forename: Nicos I
authors.initials: NI
authors.lastname: Fotiadis
authors.forename: Irfan
authors.initials: I
authors.lastname: Ahmed
authors.forename: Peter
authors.initials: P
authors.lastname: Thurley
authors.forename: Robert R
authors.initials: RR
authors.lastname: Hutchins
authors.forename: Tim
authors.initials: T
authors.lastname: Fotheringham