A case of fractured biliary self-expandable metallic stent

Abstract

An 87-year-old female was diagnosed lower CBD cancer in January 2017. The patient refused resection but underwent placement of a biliary self-expendable metallic stent (SEMS). In April 2017, she presented with abdominal pain. Endoscopic cholangiography demonstrated SEMS occlusion by sludge and blood-clot. We performed endoscopic cleaning with a retrieval-ballon catheter. In September 2017, she was admitted with recurrent cholangitis. Fluoroscopy and endoscopic images demonstrated distal migration and fracture on the distal end of SEMS. We placed a 7Fr plastic stent (PS) through the broken SEMS. 1 week later, after removing the PS, alligator-forceps were used to grasp the distal end of the fractured SEMS, which was cautiously withdrawn from the CBD. Immediately after removal, we inserted a new SEMS. The patient was discharged without any complications.

We assumed that cleaning the SEMS with a balloon caused distal migration, followed by mechanical stress in duodenum caused the fracture. Although uncommon, fracture should be considered in patients with SEMS.