title: Surgical relief of small bowel obstruction by migrated biliary stent: extraction without enterotomy.
abstract: BACKGROUND
  Distal stent migration is a well-known complication following insertion of biliary stents. Most such cases can be managed expectantly, because the stents pass through the gastrointestinal tract. However, small bowel obstruction as a result of the stent mandates surgical intervention.
  
  
  METHODS
  We report the case of a patient who had distal stent migration causing a small bowel obstruction. We successfully retrieved the stent without an enterotomy, by using a combination of laparoscopy, endoscopy, and fluoroscopy. Our unique technique greatly decreased the risk of bacterial peritonitis in this patient with decompensated cirrhosis and associated ascites, which in this patient population results in a high mortality.
  
  
  RESULTS
  Management of small bowel obstruction secondary to biliary stent migration necessitates operative intervention. Retrieval of a dislodged stent can be performed safely without subjecting the patient to an enterotomy or a small bowel resection. Postoperative morbidity should be significantly reduced by this approach.
  
  
  CONCLUSIONS
  Retrieval of biliary stents in cases of small bowel obstruction without perforation may be successfully performed without enterotomy or bowel resection. A similar approach may be applied to other foreign bodies dislodged in the small bowel.
authors: New York University Lagone Medical Center, 530 1st Ave, New York, NY 10016, USA.
authors: Karan
authors: K
authors: Garg
authors: Jonathan
authors: J
authors: Zagzag
authors: Inessa
authors: I
authors: Khaykis
authors: Howard
authors: H
authors: Liang
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D020878:Device Removal / Q000379:methods*; D016145:Endoscopy, Digestive System; D005471:Fluoroscopy; D005548:Foreign-Body Migration / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D042882:Gallstones / Q000628:therapy; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed