Abstract
We report herein on an unusual case of cecal perforation due to a migrated biliary stent. The patient was a woman in her nineties who was admitted with fever and vomiting. We suspected acute cholangitis secondary to underlying choledocholithiasis. She underwent endoscopic retrograde cholangiography (ERC), followed by the placement of a plastic stent. Thereafter, her symptoms rapidly improved and she was discharged. She presented again 4 months thereafter with fever. An X-ray showed that the stent had migrated in the pelvic cavity. Another stent was replaced for recurrent acute cholangitis. Seventeen days later, she had right lower quadrant pain. A CT scan showed that the migrated stent had perforated the cecum. The patient underwent a laparotomy under the diagnosis of cecal perforation. Intraoperatively, purulent peritonitis secondary to cecal perforation was observed due to the migrated stent. The stent was removed with a cecectomy. The postoperative course was uneventful, and she was discharged with no symptoms. Endoscopic biliary stenting is a common procedure in the management of acute cholangitis. One of the late complications of biliary stenting is migration, which infrequently results in bowel perforation. Therefore, it has been suggested that stents which have been noted to have migrated should be removed endoscopically before they cause bowel perforation.
