2021 Volume 35 Issue 4 Pages 660-667
A 73-year-old woman with unresectable locally advanced pancreatic head cancer underwent chemoradiotherapy and chemotherapy after transpapillary biliary drainage with a plastic stent (PS). Three months later, we replaced with a self-expandable metallic stent (SEMS). However one year later, the SEMS had deviated into the duodenum, so we trimmed it with APC and placed PS in the SEMS. She continued to receive chemotherapy, but was admitted to the hospital with cholangitis two years and six months later. An emergency ERC revealed choledochoduodenal fistula on the oral side of the duodenal papilla in the descending portion of the duodenum, and exposed SEMS. We experienced a case of pancreatic head cancer with choledochoduodenal fistula caused by transpapillary SEMS. It was considered that the hepatoduodenal mesentery was shortened due to the bile duct mucosal damage caused by long-term implantation of SEMS and the tumor shrinkage due to multidisciplinary treatment, and SEMS eroded and penetrated the bile duct and duodenal wall. We report it with some consideration of the literature.
