Distal sigmoid perforation secondary to migration of a biliary stent: A case report

Colonic perforation is a rare but critical condition that can lead to significant morbidity and mortality, particularly when iatrogenic in nature, such as from biliary stent migration, which occurs in less than 1 % of cases. This underscores the need for awareness among healthcare professionals regarding this potential risk and the importance of timely diagnosis and management.

We present an 80-year-old female patient admitted with severe abdominal pain and vomiting. Radiological examinations revealed free air under the diaphragm and a perforation at distal sigmoid part of the colon caused by a lodged foreign body. Instead of the standard resection and colostomy, we opted for exclusive repair of the perforated area due to the patient's stable condition. Subsequent investigations identified the foreign body as a migrated Common Bile Duct (CBD) stent from a previous ERCP procedure. The patient underwent successful repair and recovered fully after one week of hospitalization, with no complications during a six-month follow-up. Notably, it must be included that the work has been reported in line with the SCARE criteria.

Management of sigmoid perforation following CBD stenting requires careful consideration of patient stability and perforation characteristics. In this case, primary repair was justified to preserve bowel continuity. Early recognition and intervention are crucial for effectively managing iatrogenic perforations.

Sigmoid perforation, while rare, can arise from biliary stenting procedures; thus, patients with abdominal pain post-procedure should be thoroughly investigated. To ensure patient safety and minimize the risk of surgical complications, it is important to remove the plastic biliary stents promptly after their intended use. Tailored management strategies are vital to prevent severe outcomes and improve prognosis, demonstrating that individualized treatment can minimize morbidity associated with invasive surgical procedures.