Sigmoid colon perforation caused by migrated plastic biliary stents: a case report
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CASE REPORT
Sigmoid colon perforation caused by migrated plastic biliary stents: a case report Yong Tao 1 & Jiegen Long 1 Accepted: 25 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Introduction Endoscopic migration of plastic biliary stents is performed by endoscopic retrograde cholangiopancreatography (ERCP) for biliary and pancreatic diseases. This plays an increasingly important role. Intestinal perforation caused by stent migration is one of the complications. Although sigmoid colon perforation caused by stent migration is rare, it can be lifethreatening. This case shows us that we should increase awareness of sudden abdominal pain after ERCP. Method We provide a review of the clinical manifestations, imaging data of this case, and the literature related to the perforation caused by stent migration. Results A male patient had a history of choledocholithiasis, cholecystolithiasis, and biliary pancreatitis treated with ERCP and a pancreatic stent. After the operation, the patient developed cholangitis and was treated with ERCP and a plastic biliary stent. This patient was admitted to the emergency department with sudden lower abdominal pain. A CT scan showed sigmoid colon perforation by a foreign body and infra-diaphragmatic free air. An emergency surgery confirmed that the stent had caused the perforation. The patient was then treated with sigmoid colectomy and sigmoidostomy. Discussion Biliary stent migration after ERCP is rare, but intestinal perforation caused by migration should be considered in cases of abdominal pain of unknown cause. Keywords ERCP . Biliary stent . Migration perforation
Case presentation A 54-year-old male patient presented at the hospital with right upper abdominal pain and shivering. A physical examination showed jaundice and right upper abdominal tenderness with muscular tension. An auxiliary B-ultrasound showed gallstones and choledochectasis. A CT showed acute pancreatitis choledochectasis and cholecystolithiasis. Amylase was 3254.00 μ/L, T-Bil was 90.8 μmol/L, and DBil was 66.3 μmol/L. The patient was treated with emergency endoscopic retrograde cholangiopancreatography (ERCP) along with sphincterotomy of duodenal papilla, choledocholithotomy, pancreatic stent, and nasobiliary
drainage. During the operation, congestion of duodenal papilla, bile sludge, and choledocholithiasis were observed. After operation, jaundice decreased slowly, and the patient began to experience shivering and high fever. Residual stones were evaluated by radiography. Then ERCP was performed, and a plastic biliary stent was placed. During
* Jiegen Long [email protected] Yong Tao [email protected] 1
Department of General Surgery, People’s Hospital of Banan District, Chongqing 401320, China
Fig. 1 CT scan of the biliary stent in sigmoid colon
Int J Colorectal Dis
Fig. 2 CT scan of the biliary stent in sigmoid colon
Fig. 4 Gross pathologic images of the biliary stent
the operation, the common bile duct was visibly dilated, with a maximum diameter of about 1.3 cm. Ja
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