Endoscopic Retrieval of a Migrated Biliary Stent Causing Duodenal Perforation in a Patient With Mirizzi Syndrome

Preoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting is a widely used intervention to achieve biliary drainage in patients with Mirizzi syndrome. While ERCP offers a minimally invasive approach to relieve obstruction and aid surgical management, it is not without risks. Reported complications of biliary stenting include cholangitis, pancreatitis, stent occlusion, and migration. In rare circumstances, migrated stents may result in intestinal perforation, most often involving the duodenum. Such events can be serious and require prompt recognition and management to prevent secondary complications such as peritonitis or intra-abdominal sepsis. We describe the case of a woman in her twenties who developed a delayed duodenal perforation caused by the distal migration of a straight plastic biliary stent following ERCP for Mirizzi syndrome. The stent traversed the second part of the duodenum and extended into the retroperitoneal space down to the pelvis. It was successfully removed endoscopically under sedation, with defect closure achieved using endoscopic clips. This case highlights a rare but significant complication of biliary stenting and demonstrates the feasibility of safe endoscopic management.