Laparoscopic distal pancreatectomy for retrieval of a proximally migrated pancreatic stent.
OBJECTIVE
Pancreatic stents placed by ERCP are common in the treatment of benign and malignant pancreatic and biliary disease. Proximal migration of the stent into the duct occurs in 2% to 5% of cases, often resulting in pancreatitis. Although technically challenging,  proximally migrated pancreatic stents can usually be removed endoscopically. Little has been written about surgical management of irretrievable stents, and no reports of laparoscopic approaches were found.


METHODS
We report on a case of unsuccessful ERCP retrieval of a proximally  migrated pancreatic stent.


RESULTS
Using laparoscopy, we exposed the pancreas and used ultrasound to locate the distal end of the stent. We incised the pancreas at that point, removed the stent, and completed the distal pancreatectomy with splenectomy.


CONCLUSIONS
Several  case series on retrieval of migrated pancreatic stents are reviewed.


CONCLUSIONS
Although ERCP is often successful and sometimes requires several attempts, we recommend surgical consultation after the first or second failed ERCP.
General Surgery, National Naval Medical Center Bethesda, Bethesda, MD 20889, USA. Donald.lucas@med.navy.mil
Donald J
DJ
Lucas
Jacob J
JJ
Glaser
Jonathan P
JP
Pearl
D000328:Adult; D001657:Biliary Dyskinesia / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D018810:Magnetic Resonance Angiography; D010179:Pancreas / Q000000981:diagnostic imaging; D010180:Pancreatectomy / Q000379:methods*; D010183:Pancreatic Ducts; D019233:Retreatment; D046628:Sphincter of Oddi Dysfunction / Q000601:surgery; D016717:Sphincterotomy, Endoscopic; D015607:Stents / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography