A case of straight bile duct stent penetrating the Vater's papilla

Abstract

The patient was a woman in her 70s. She was referred to our hospital with epigastric pain and vomiting. She was diagnosed with acute purulent cholangitis and gallstone pancreatitis. An emergency ERCP was performed, which revealed a common bile duct stone. After EST small incision, an EBD tube was placed. Her symptoms improved after conservative treatment. After 3 months, another ERCP was performed for stone removal, during which we found that the stent was penetrating the Vater's papilla. The stent was removed using forceps. Cholangiography was performed from the Vater's papilla and the penetrating part, and the common bile duct stone was confirmed. The calculus was completely removed through the Vater's papilla. Although a complication rate of 0.994% associated with ERCP-related procedures has been reported in a nationwide survey, there was no report of Vater's papilla penetration. We had performed ERCP in 450 patients for the past 3 years and encountered only 2 patients (0.4%) with Vater's papilla penetration. In both the patients, the same type of straight side flap was placed after EST small incision for cholangitis treatment.