An 83-year-old female who presented with vomiting was diagnosed with stenosis from the duodenal bulb to the gastric antrum caused by unresectable pancreatic ductal adenocarcinoma. A self-expandable metal stent (SEMS) was placed under endoscopy at the obstructed region. Following discharge, she underwent 7 courses of gemcitabine+nab-paclitaxel chemotherapy as an outpatient. She developed abdominal pain 205 days after SEMS placement, and abdominal computed tomography revealed intraperitoneal free gas. Emergency laparotomy was performed for a diagnosis of upper gastrointestinal perforation. The patient regained capacity to take food after surgery, and was released on postoperative day 46. The present case is an example of perforation occurring after placement of a metallic stent, a rare complication. We report our experience in a case with late onset of perforation, while also reviewing the literature.
