Sigmoid Diverticulitis and Perforation Secondary to Biliary Stent Migration

Area of Science:

• Gastroenterology
• Surgical Innovation
• Medical Device Complications

Background:

• Biliary stent migration occurs in 5-10% of patients following endoscopic retrograde cholangiopancreatography (ERCP).
• While typically benign, migration can lead to rare but serious complications like intestinal perforation.
• Risk factors for perforation include specific stent types and co-existing pathologies.

Observation:

• A 79-year-old female presented with acute abdominal pain four weeks post-ERCP for choledocholithiasis.
• CT imaging revealed a migrated biliary stent perforating the sigmoid colon, evidenced by free air.
• Laparoscopic assessment confirmed colonic perforation by the biliary stent.

Findings:

• The patient underwent conversion to open surgery and a Hartmann's procedure with end colostomy.
• This case highlights a rare instance of biliary stent migration causing significant gastrointestinal trauma.
• Perforation sites commonly include the duodenum, small bowel, and colon, with increased risk in patients with diverticular disease or hernias.

Implications:

• Straight biliary stents may have a higher propensity for migration and subsequent perforation.
• Consideration for early stent removal in patients with known diverticular disease and straight biliary stents is recommended.
• This case underscores the importance of vigilance for rare stent-related complications.