2018 Volume 60 Issue 1 Pages 42-47
A 65-year-old female was admitted for endoscopic retrograde cholangiopancreatography (ERCP) examination because her private doctor found abnormal dilatation of her pancreatic duct during abdominal ultrasound examination. ERCP showed that the pancreatic duct was smooth and regular but had a significant bend at the neck of the pancreas. Although a single pig-tailed plastic stent was inserted into the main pancreatic duct to prevent ERCP pancreatitis, the patient presented to the emergency room 17 days after ERCP for severe abdominal pain and hypotension. Laboratory blood testing showed severe inflammation, with a white blood cell count of 16,860/μL and a C-reactive protein level of 20.70 mg/dL. Computed tomography and ERCP showed a retroperitoneal abscess and a pancreatic fistula that had been induced by stent migration. After removing the migrated stent using endoscopy, the pancreatic fistula was treated with a long plastic stent with double flaps to inhibit migration. The retroperitoneal abscess was treated with two drainage tubes placed into the retroperitoneal cavity, via percutaneous transhepatic and endoscopic naso-pancreatic routes. The patient recovered and was discharged 40 days later without further surgical treatment. She has remained free of any symptom during one year of follow-up. Complications of pancreatic stents are rare, but they can induce severe illness.
