scholarly journals Complications due to Biliary Stent Deviation

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Kinoshita Kumar ◽  
◽  
Fukuchi S ◽  
Murakami K ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endoscopic Sphincterotomy ◽  
Clinical Symptoms ◽  
Acute Cholangitis ◽  
Biliary Stent ◽  
Plastic Stents ◽  
Duodenal Perforation ◽  
Early Complications ◽  
Biliary Stents ◽  
Uterine Appendage

We often encounter complications from biliary stents used as a treatment for obstructive jaundice and acute cholangitis. Early complications after stent placement include pancreatitis, bleeding, and duodenal perforation [1]. Stent deviation is also a complication. This is particularly prominent for plastic stents, where stent deviation is observed in 6-18.7 % of cases [2]. Stent deviation is more common among patients who have undergone endoscopic sphincterotomy (Figure 1). Most deviated biliary plastic stents are excreted in stool or collected endoscopically, but, very rarely, complications causing gastrointestinal perforation have been reported. We have described deviated biliary plastic stents causing sigmoid colon diverticulum perforation and even uterine appendage penetration (Figure 2). Diagnosis can be made from clinical symptoms and abdominal computed tomography. Treatment is basically surgery. Biliary stent-related complications are inevitable, and sometimes become serious. On suspicion of such complications, the most important issue is to accurately and rapidly diagnose complications and conduct appropriate management.

Perforation Due to Biliary Stent: Case Report and Review

2021 ◽  
Author(s):  
Flavio Tirelli ◽  
Paolo Mirco ◽  
Pietro Fransvea ◽  
Gilda Pepe ◽  
Andrea Tringali ◽  
...  
Keyword(s):  
Bowel Perforation ◽  
Multiorgan Failure ◽  
Stent Migration ◽  
Biliary Stent ◽  
Duodenal Perforation ◽  
Single Session ◽  
Biliary Stents ◽  
Stone Size ◽  
Endoscopic Extraction ◽  
Intrahepatic Lithiasis

AbstractEndoscopic retrograde cholangiopacreatography (ERCP) has a pivotal role for the management of various malignant and benign pancreatico-biliary disorders. Biliary stents migration is reported in 5 to 10% of the cases and can be responsible for bowel perforation. An 80-year-old Caucasian man was referred to our hospital for an attempt at endoscopic extraction of massive intrahepatic lithiasis; during ERCP, complete stone extraction in a single session was not achievable and three plastic biliary stents were inserted to promote stone size reduction and perform a delayed cholangioscopy-assisted lithotripsy. During the next 2 days, the patient developed worsening abdominal pain with no fever, nausea, and vomiting. An emergency computed tomography showed a duodenal perforation due to biliary stent migration. Upon laparotomy, a direct suture of the duodenal lesion was performed. The patient died 3 days later because of a multiorgan failure. ERCP-related complications may occur in 5 to 15% of the cases and biliary stent migration accounts for 5 to 10% of these cases; less than 1% of stents migration determines bowel perforation, most commonly in the duodenum. Stent-related bowel perforation can be clinically misleading and early diagnosis and treatment are sometimes challenging. Whether the duodenal perforation is intra- or retroperitoneal should be taken into account to choose the best therapeutic approach.

scholarly journals Duodenal Perforation Secondary to Migrated Biliary Stent: A Rare and Serious Complication of Endoscopic Retrograde Cholangiopancreatography

2018 ◽  
Vol 09 (04) ◽  
pp. 193-195
Author(s):  
Vipul D. Yagnik ◽  
Vismit P. Joshipura
Keyword(s):  
Abdominal Pain ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Bile Duct Stone ◽  
Intestinal Wall ◽  
Biliary Stent ◽  
Duodenal Perforation ◽  
Biliary Stents ◽  
Endoscopic Retrograde

AbstractAlthough migration of biliary stents is not uncommon, stent‑induced perforation of the intestinal wall is a rare and serious complication. We report a case of duodenal perforation secondary to migrated biliary stent kept for obstructive jaundice for common bile duct stone in a 64‑year‑old male. Intestinal perforation secondary to migrated stent should be considered in patients reported with abdominal pain and sepsis after an endoscopic retrograde cholangiopancreatography with biliary stent placement.

scholarly journals A rare complication of ERCP: duodenal perforation due to biliary stent migration

2020 ◽  
Vol 08 (11) ◽  
pp. E1530-E1536
Author(s):  
Mark A. Gromski ◽  
Benjamin L. Bick ◽  
David Vega ◽  
Jeffrey J. Easler ◽  
James L. Watkins ◽  
...  
Keyword(s):  
Biliary Stricture ◽  
Rare Complication ◽  
Stent Migration ◽  
Plastic Stents ◽  
Duodenal Wall ◽  
Duodenal Perforation ◽  
Biliary Stents ◽  
Endoscopic Retrograde ◽  
Factors Associated ◽  
Migration Event

Abstract Background and study aims Perforation of the duodenal wall opposing the major papilla due to a migrated pancreatobiliary stent rarely has been described in the literature as a complication of endoscopic retrograde cholangiopancreatography (ERCP). Factors associated with perforation from migrated stents from ERCP are unknown. Patients and methods This was a retrospective, observational study. Patients were identified from January 1, 1994 to May 31, 2019 in a prospectively maintained ERCP database. Results Eleven cases of duodenal perforation from migrated pancreatobiliary stents placed at ERCP were identified during the study period. All cases involved biliary stents, placed for biliary stricture management. The perforating stent was plastic in 10 cases (91 %). This complication occurred in one in 2,293 ERCP procedures in which a pancreatobiliary stent was placed. Conclusion This complication is more common with biliary stents compared to pancreatic stents. This may be related to the angle of exit of biliary stents being more perpendicular to the opposing duodenal wall and the near exclusive use of external pigtail plastic stents in the pancreatic duct. All perforating plastic stents were ≥ 9 cm in length. Longer stents may provide leverage for perforation with a migration event.

scholarly journals A85 THE CLINICAL IMPACT OF COVID-19 DELAYS ON PLASTIC BILIARY STENT REMOVAL IN NOVA SCOTIA

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 54-56
Author(s):  
D R Lim ◽  
M Tsai ◽  
S E Gruchy ◽  
J Jones ◽  
G Williams ◽  
...  
Keyword(s):  
Survival Analysis ◽  
Nova Scotia ◽  
Stent Placement ◽  
Biliary Stent ◽  
Biliary Stents ◽  
Stent Occlusion ◽  
Stent Removal ◽  
Kaplan Meier ◽  
And Migration

Abstract Background The COVID-2019 pandemic continues to restrict access to endoscopy, resulting in delays or cancellation of non-urgent endoscopic procedures. A delay in the removal or exchange of plastic biliary stents may lead to stent occlusion with consensus recommendation of stent removal or exchange at three-month intervals [1–4]. We postulated that delayed plastic biliary stent removal (DPBSR) would increase complication rates. Aims We aim to report our single-centre experience with complications arising from DPBSR. Methods This was a retrospective, single-center, observational cohort study. All subjects who had ERCP-guided plastic biliary stent placement in Halifax, Nova Scotia between Dec 2019 and June 2020 were included in the study. DPBSR was defined as stent removal >=90 days from insertion. Four endpoints were assigned to patients: 1. Stent removed endoscopically, 2. Died with stent in-situ (measured from stent placement to documented date of death/last clinical encounter before death), 3. Pending removal (subjects clinically well, no liver enzyme elevation, not expired, endpoint 1 Nov 2020), and 4. Complication requiring urgent reintervention. Kaplan-Meier survival analysis was used to represent duration of stent patency (Fig.1). Results 102 (47.2%) had plastic biliary stents placed between 2/12/2019 and 29/6/2020. 49 (48%) were female, and the median age was 68 (R 16–91). Median follow-up was 167.5 days, 60 (58.8%) subjects had stent removal, 12 (11.8%) died before replacement, 21 (20.6%) were awaiting stent removal with no complications (median 230d, R 30–332), 9 (8.8%) had complications requiring urgent ERCP. Based on death reports, no deaths were related to stent-related complications. 72(70.6%) of patients had stents in-situ for >= 90 days. In this population, median time to removal was 211.5d (R 91-441d). 3 (4.2%) subjects had stent-related complications requiring urgent ERCP, mean time to complication was 218.3d (R 94–441). Stent removal >=90 days was not associated with complications such as occlusion, cholangitis, and migration (p=1.0). Days of stent in-situ was not associated with occlusion, cholangitis, and migration (p=0.57). Sex (p=0.275), cholecystectomy (p=1.0), cholangiocarcinoma (p=1.0), cholangitis (p=0.68) or pancreatitis (p=1.0) six weeks prior to ERCP, benign vs. malignant etiology (p=1.0) were not significantly associated with stent-related complications. Conclusions Plastic biliary stent longevity may have been previously underestimated. The findings of this study agree with CAG framework recommendations [5] that stent removal be prioritized as elective (P3). Limitations include small sample size that could affect Kaplan-Meier survival analysis. Despite prolonged indwelling stent time as a result of COVID-19, we did not observe an increased incidence of stent occlusion or other complications. Funding Agencies None

scholarly journals Asymptomatic Presentation of Aggressive Ossifying Fibroma:A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Roopashri Rajesh Kashyap ◽  
Gopakumar R. Nair ◽  
Subhas Babu Gogineni
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Head And Neck ◽  
Clinical Symptoms ◽  
Neck Region ◽  
Ethmoid Sinus ◽  
Ossifying Fibroma ◽  
Head And Neck Region ◽  
Aggressive Form ◽  
Aggressive Tumors

Ossifying fibromas form a part of the spectrum of fibro-osseous lesions of the jaws. They are rare, benign, nonaggressive tumors that are commonly seen in head and neck region. This paper presents the case of a 40-year-old female patient presented with minimal clinical symptoms, diagnosed to be suffering from aggressive form of ossifying fibroma of maxilla involving the maxillary sinus and ethmoid sinus. This paper emphasizes the importance of computed tomography in diagnosing such unapparent aggressive tumors.

scholarly journals Late Complications following Endoscopic Sphincterotomy for Choledocholithiasis: A Swedish Population-Based Study

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
A. Langerth ◽  
L. Brandt ◽  
A. Ekbom ◽  
B.-M. Karlson
Keyword(s):  
Acute Pancreatitis ◽  
Endoscopic Sphincterotomy ◽  
Acute Cholangitis ◽  
Common Bile Duct Stones ◽  
Population Based ◽  
Late Complications ◽  
Swedish Population ◽  
The Mean

In order to assess the risk of long-term complications following endoscopic sphincterotomy (ES) for common bile duct stones (CBDS), we conducted a cohort study. The study included 1,113 patients who underwent ES for CBDS in six different hospitals in central Sweden between 1977 and 1990. Through the use of the Swedish population registry, each patient was assigned five population-based controls matched for sex and age. Linkage to the Inpatient Registry yielded information on morbidity and mortality for the patients as well as for the controls. After one year of washout, there were 964 patients available for follow-up. The mean age was 70.6 years, 57% were women, and the mean length of follow-up was 8.9 years. The patients’ overall morbidity was significantly higher and we observed a tendency towards increased mortality as well. Recurrent CBDS was diagnosed in 4.1% of the patients. Acute cholangitis with a hazard ratio (HR) of 36 (95%CI 11–119.4) was associated with recurrent CBDS in 39% of the patients. HR for acute pancreatitis was 6.2 (95%CI 3.4–11.3) and only one patient had CBDS at the same time. In conclusion, we consider acute pancreatitis and cholangitis both as probable long-term complications after ES.

scholarly journals Rare incidence of non-secretory myeloma with talaromycosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiting Qin ◽  
Ye Qiu ◽  
Yanmei Huang ◽  
Mianluan Pan ◽  
Dong Lan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Community Acquired Pneumonia ◽  
Pathological Examination ◽  
Subcutaneous Nodules ◽  
Lung Lymph

Abstract Background Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Case presentation We retrospectively reviewed the case of a male (without human immunodeficiency virus infection) with fever, thoracalgia, swollen lymph nodes, and subcutaneous nodules who presented to the First Affiliated Hospital of Guangxi Medical University in February 2014. Chest computed tomography revealed patchy infiltration and positron emission tomography/computed tomography showed increased metabolic activity in the lower-right lung, lymph nodes, left ninth rib, and right ilium. Pathological examination of the lung, lymph nodes, subcutaneous nodules, and bone marrow showed no malignancy, he was diagnosed with community-acquired pneumonia. His clinical symptoms did not improve after anti-bacterial, anti-Mycobacterium tuberculosis, and anti-non-M. tuberculosis treatment. Later, etiological culture and pathological examination of the subcutaneous nodule proved TM infection, and the patient was re-diagnosed with disseminated TSM, which involved the lungs, lymph nodes, skin, bone, and subcutaneous tissue. After antifungal treatment, the patient showed significant improvement, except for the pain in his bones. Imaging showed aggravated osteolysis, and bone marrow biopsy and immunohistochemistry indicated NSMM. Thus, we conclusively diagnosed the case as NSMM with TSM (involving the lungs, lymph nodes, skin, and subcutaneous tissue). His condition improved after chemotherapy, and he was symptom-free for 7 years. Conclusion TM infection is rare in individual with NSMM. Since they have clinical manifestation in common, easily causing misdiagnosis and missed diagnosis, multiple pathological examinations and tissue cultures are essential to provide a differential diagnosis.

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