2017 Volume 59 Issue 1 Pages 56-61
This report describes a 65-year-old woman who underwent insertion of a self-expandable metallic stent （SEMS） for malignant biliary obstruction caused by gallbladder cancer. The cancer had metastasized to the cervical column, and was invading the liver and duodenum. The patient was admitted to our hospital because of nausea and vomiting. Detailed examination showed gallbladder cancer causing duodenal obstruction and perforation of the first part of the duodenum. We attempted to perform endoscopic placement of a duodenal SEMS, but the guidewire migrated into the fistula and could not pass through the stricture. Thus, we used a balloon catheter with a side hole, which is generally used for endoscopic removal of biliary stones. The balloon catheter with the side hole was inserted into the fistula, and the balloon was dilated to occlude the fistula. The guidewire was pushed through the side hole against the dilated balloon to change its direction. This action allowed us to finally pass the guidewire through the stricture. The endoscopic placement of the duodenal SEMS was successful and it enabled the patient to begin oral intake on the day following the procedure. This finding shows that a balloon catheter with a side hole can be effective for insertion of a duodenal SEMS past a stricture in a patient with malignant gastric outlet obstruction with duodenum perforation.
