Perforation and Abscess After Biliary Stent Placement
Perforation and Abscess After Biliary Stent Placement
Introduction: 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.
Case presentation: 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.
Conclusion: 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.
Complications after endoscopic insertion of retrievable plastic biliary stents are well recognised, including perforation of the duodenum, small bowel and large bowel after migration of the stent. Retrievable plastic stents are usually inserted endoscopically, but in our institution are also inserted radiologically when endoscopic placement has failed, and the patient has benign disease or is likely to undergo curative surgery. We report a case of delayed perforation and abscess formation after radiological insertion of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting. The diagnosis and treatment options are discussed.
Abstract and Introduction
Abstract
Introduction: 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.
Case presentation: 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.
Conclusion: 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.
Introduction
Complications after endoscopic insertion of retrievable plastic biliary stents are well recognised, including perforation of the duodenum, small bowel and large bowel after migration of the stent. Retrievable plastic stents are usually inserted endoscopically, but in our institution are also inserted radiologically when endoscopic placement has failed, and the patient has benign disease or is likely to undergo curative surgery. We report a case of delayed perforation and abscess formation after radiological insertion of a plastic stent. To the best of our knowledge, this is the first report of this complication after radiological stenting. The diagnosis and treatment options are discussed.
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