Successful endoscopic closure with an over-the-scope clip for sigmoid colon perforation due to bile duct stent migration

An 86-year-old woman presented with a history of endoscopic papillary sphincterotomy for bile duct stones and diverticulitis. The patient was admitted as an emergency case of acute cholangitis due to choledocholithiasis, underwent endoscopic bile duct stenting, and was discharged with a plan for endoscopic lithotripsy. One month later, the patient was readmitted owing to abdominal pain. Abdominal computed tomography at admission showed that the bile duct stent had migrated to the sigmoid colon and the presence of a small amount of extraintestinal gas, suggesting a colonic perforation. Lower gastrointestinal endoscopy showed adhesions and intestinal stenosis in the sigmoid colon, probably after diverticulitis, and the bile duct stent that had perforated the same site. The stent was removed and endoscopic closure of the perforation was performed using an over-the-scope clip. Abdominal computed tomography 8 days after the closure showed no extraintestinal gas. The patient resumed eating and was discharged on the 14th day of admission. There was no recurrence of abdominal pain. Endoscopic closure of sigmoid colon perforation due to bile duct stent migration using an over-the-scope clip has not been reported thus far, and it may be a new treatment option in the future.

A bile duct stent broken during repeat pregnancy in a post-liver transplant patient

A young female patient who developed anastomotic biliary stricture following an orthotopic liver transplantation was observed. A self-expandable metallic stent was placed to correct the stricture. At the 8th month of her repeat pregnancy, the stent broke asymptomatically into half. Fortunately, the second childbirth, like the first one, had no complications. Eighteen months later, due to obstruction of fragments by sludge and gallstones, re-stenting was performed with a coated biliary stent. Four years and five months later, recurrent jaundice occurred due to occlusion of the second stent. This was addressed by surgical removal of both stents. Two years after surgery, the bile ducts remain completely patent. We found only two cases in literature on a similar extremely rare biliary stenting complication. It has been suggested that stent deformation may be related to pregnancy. The feasibility of using stenting in benign biliary strictures in some clinical situations is discussed.