Stent migration under EUS-guided pseudocyst drainage (EUS-PCD) for walled-off necrosis

Abstract

A 70-year-old man with pancreatic carcinoma underwent resection of the pancreatic body and tail with splenectomy. Postoperatively, a pancreatic fistula was identified on abdominal computed tomography (CT) . As he was asymptomatic, the patient was placed under observation. One month after surgery, the size of the pancreatic fistula─as shown on abdominal CT─had increased, and was accompanied by fever and abdominal pain. The patient was diagnosed with infected walled-off necrosis (WON) , and EUS-guided pseudocyst drainage (EUS-PCD) was performed immediately. Placement of a 4-cm plastic stent and a nasal-drainage tube were attempted using EUS-PCD. However, proximal migration of the stent into the WON occurred during the procedure. The 4-cm stent was left in situ, and a 9-cm plastic stent and a nasal-drainage tube were additionally placed. Endoscopic necrosectomy was performed five days later, and the migrated stent was retrieved at the same time using a front-view type endoscope.