<p>Stents are often placed during endoscopic retrograde cholangiopancreatography(ERCP) to prevent the second obstruction of common bile duct(CBD) and drain bile. One of the complications after the placement of stent is stent migration. Herein, we report a case of retrieval of double proximally migrated metal stents, which is very rare. A female complaining of poor appetite for more than 20 days presented to the gastroenterology department. Upper abdominal magnetic resonance revealed stones in the upper CBD. Stones were removed from her CBD through ERCP and a covered metal stent was placed in her CBD. Four days after first discharge, she was re-hospitalized complaining of fever. Upper abdominal CT showed a retroperitoneal abscess was formed. After antibiotics and drainage, her abscess was reduced. A second ERCP was performed and showed the stent had entirely migrated proximally into the bile duct. A second covered metal stent was placed in the CBD. Three months after the second ERCP, the patient came back and accepted a third ERCP. During the procedure, duodenoscopy showed the second stent had migrated proximally into the bile duct entirely. Two stents were retrieved successfully by endoscopist. Stents are usually placed in common bile duct in order to drain bile following ERCP. Although there are many designs to prevent the migration of stents, it is still inevitable for stents to migrate. The length of stent was related to the direction of stent migration. Endoscopic retrieval is the first-line approach for the treatment of migrated stent. We reported a case of Bile duct perforation following ERCP and retrieval of double proximally migrated biliary metal stents. Endoscopic retrieval is a safe approach for the treatment of migrated stent, even for double migrated stents.</p>

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Bile Duct Perforation during ERCP: a Case of Sequential Proximal Migration and Successful Endoscopic Retrieval of Two Covered Metal Stents

  • Yuankang Xie,
  • Chunping Zhu,
  • Jiaming Huang

摘要

Stents are often placed during endoscopic retrograde cholangiopancreatography(ERCP) to prevent the second obstruction of common bile duct(CBD) and drain bile. One of the complications after the placement of stent is stent migration. Herein, we report a case of retrieval of double proximally migrated metal stents, which is very rare. A female complaining of poor appetite for more than 20 days presented to the gastroenterology department. Upper abdominal magnetic resonance revealed stones in the upper CBD. Stones were removed from her CBD through ERCP and a covered metal stent was placed in her CBD. Four days after first discharge, she was re-hospitalized complaining of fever. Upper abdominal CT showed a retroperitoneal abscess was formed. After antibiotics and drainage, her abscess was reduced. A second ERCP was performed and showed the stent had entirely migrated proximally into the bile duct. A second covered metal stent was placed in the CBD. Three months after the second ERCP, the patient came back and accepted a third ERCP. During the procedure, duodenoscopy showed the second stent had migrated proximally into the bile duct entirely. Two stents were retrieved successfully by endoscopist. Stents are usually placed in common bile duct in order to drain bile following ERCP. Although there are many designs to prevent the migration of stents, it is still inevitable for stents to migrate. The length of stent was related to the direction of stent migration. Endoscopic retrieval is the first-line approach for the treatment of migrated stent. We reported a case of Bile duct perforation following ERCP and retrieval of double proximally migrated biliary metal stents. Endoscopic retrieval is a safe approach for the treatment of migrated stent, even for double migrated stents.