Migrated biliary stent causing Meckel's diverticulitis and ileal perforation: a rare cause of acute abdomen

Migration of plastic biliary stents is a recognized complication of endoscopic retrograde cholangiopancreatography (ERCP), although it is usually asymptomatic and self-limiting. Intestinal perforation due to stent migration is rare, and involvement of Meckel's diverticulum is exceedingly uncommon. We report a 70-year-old woman who presented with acute abdomen approximately one year after ERCP with placement of a 10F-10 cm plastic biliary stent for choledocholithiasis. Computed tomography revealed small bowel obstruction and a linear hyperdense intraluminal structure consistent with a foreign body. Emergency surgery identified a migrated biliary stent impacted within a Meckel's diverticulum located 40 cm proximal to the ileocecal valve. One end of the stent was lodged in the diverticulum, while the opposite end perforated the adjacent ileal loop, resulting in localized peritonitis. Segmental small bowel resection with primary side-to-side anastomosis was performed. The postoperative course was complicated by respiratory failure requiring prolonged ventilatory support; however, the patient recovered and was discharged in good condition. This case highlights a rare bidirectional perforation mechanism caused by long-term indwelling plastic biliary stent migration. In patients with a history of ERCP presenting with acute abdomen, migrated stents should be considered in the differential diagnosis. Regular surveillance and timely removal of plastic biliary stents are essential to prevent severe late complications.