Duodenal perforation due to biliary stent migration: Report of two cases

Abstract text (incl. references and figure legends)

CASE HISTORY:

We present two unusual clinical cases of a 62 year-old man and a 69 year-old woman presented to our emergency department due to acute abdominal pain and fever; the first was affected by benign biliary stricture and the second patient by locally advanced pancreatic carcinoma. The man received ERCP and biliary plastic stent placement three months before and the woman almost two months before, she was on neoadjuvant treatment for her pancreatic cancer.

CLINICAL FINDINGS:

Both patients presented with upper abdomen tenderness, rebound tenderness and severe leukocytosis.

RESULTS:

CT scan revealed pneumoperitoneum due to biliary stent migration and perforation of the third portion of duodenum.

THERAPY AND PROGESSIONS:

In the fisrt case perforation was located in the third portion of the duodenum, in the second case near the angle of Treiz. Stent removal, primary suture of the injury and abdominal toilette were performed for both cases. Postoperative courses were regoular for both patients.

COMMENTS:

Biliary stents are the preferred method of managing malignant and benign biliary obstruction. Potential complications include stent occlusion, stent migration and cholangitis. Stent migration occurs in about 5-10% of biliary stenting patients and may be either proximal or distal. Intestinal perforation secondary to stent migration is rare and has been reported in the caecum, in the sigmoid colon and in the duodenum. Duodenal perforation is seen in most of the cases, explanation being the thin wall of the organ and relative fixed position of the duodenum, in particoular close to the angle of Treitz.

REFERENCES:

Ida Bagus B. JGH Open 2021;5(8):968-70

Wu X, Li G, Liu Z. Ann Trasl Med 2020;8(24):1690

Arhan M, Odemis B, Parlak E et al. Surg Endosc 2009;23:769-775

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