Journal of Postgraduate Medicine Medknow Publications and Staff Society of Seth GS Medical College and KEM Hospital, Mumbai, India ISSN: 0022-3859 EISSN: 0972-2823 Vol. 55, Num. 3, 2009, pp. 196-196

Journal of Postgraduate Medicine, Vol. 55, No. 3, July-September, 2009, pp. 196

Case Snippet

Silent percutaneous migration of plastic biliary stent through ileum

Joshi MA, Thakur BA, Dhopade TG, Kamble RS

Department of Surgery, Gastroenterology Surgical Services, L. T. M. Medical College, Sion, Mumbai - 400 022, India

Correspondence Address: Dr. Mohan Joshi, Department of Surgery, Gastroenterology Surgical Services, L. T. M. Medical College, Sion, Mumbai - 400 022, India
Joshimo@vsnl.com

Code Number: jp09059

PMID: 19884746

DOI: 10.4103/0022-3859.57402

A 62-year-old male patient had undergone laparoscopic later converted to open cholecystectomy at another institute. He was referred to us for the treatment of postoperative jaundice by endotherapy. On admission he was subjected to Endoscopic Retrograde Cholangiography (ERC) which revealed a stricture in the common bile duct (CBD). This was dilated and initially a 7 F stent was placed. This normalized his liver functions and he was advised to follow up after three months for stent exchange with a large caliber one. When he presented for the same the 7 F stent had passed off and migrated from the biliary tract. The patient was unaware of passing the stent per anus in feces. This time the CBD was dilated with balloon and a tapered 10 F Teflon stent was placed. After about six months from the date of first ERC patient reported to us with passage of a black color tube [Figure - 1] from his abdominal scar without any other symptoms. Patient was on full diet and did not have any abdominal symptoms whatsoever. A computed tomography (CT) scan of the abdomen revealed one end of the stent in the terminal ileum which was adherent to the abdominal wall at the site of the scar [Figure - 2]. The 10F stent was in the biliary tract in proper position [Figure - 3].

Such silent percutaneous migration of plastic biliary stent is very rare. This could be attributed to adherence of small bowel at the site of previous surgery. In our patient adherence of small bowel was seen on CT scan with the anterior abdominal wall with kinking of the ileum. This resulted in penetration of stent through the walls of the intestine and the abdominal wall without any peritoneal symptoms or peritonitis.

Copyright 2009 - Journal of Postgraduate Medicine

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