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An unusual complication encountered incidentally at laparoscopic cholecystectomy: a case series
Mohammed Mohsin Uzzaman1, Manojkumar S Nair, Fiona Myint
1Department of General Surgery, North Middlesex University Hospital, 62 Kensington Avenue, London E12 6NP, UK. mohsinuzzaman@yahoo.co.uk
Insights
Common bile duct (CBD) stent erosion is a rare complication. Early detection and removal of biliary stents can prevent surgical complications during laparoscopic cholecystectomy.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Biliary stents are used to treat common bile duct stones.
- Erosion of the common bile duct by an in situ stent is an uncommon complication.
Observation:
- A case series identified four patients with common bile duct (CBD) erosion from an indwelling pigtail stent.
- These stents were placed after endoscopic retrograde cholangiopancreatography (ERCP) for gallstone removal.
Findings:
- Stent erosion complicated laparoscopic cholecystectomy in two patients, requiring conversion to open surgery.
- Stent removal was achieved surgically, endoscopically, or spontaneously.
- No patients required definitive surgical repair or T-tube placement.
Implications:
- Common bile duct stent erosion increases surgical complexity and risk.
- Prompt removal of biliary stents is recommended to mitigate this complication.
- Conservative management is often sufficient for CBD stent erosion.
Introduction:
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.
Method:
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.
Conclusion:
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.
