Delayed removal of a deeply migrated pigtail pancreatic stent in a normal pancreatic duct.

A 57-year-old man underwent endoscopic retrograde cholangiopancreatography (ERCP) for multiple bile duct and gallbladder stones. During the ERCP, we attempted to insert a prophylactic 5-Fr, single pigtail pancreatic stent (Cook Endoscopy, Winston-Salem, North Carolina, United States) because biliary cannulation is difficult and the pancreatic duct is frequently cannulated unintentionally; however the pancreatic stent migrated deep into the normal pancreatic duct and the pigtail portion of the stent curled into the inner pancreatic duct (●" Fig.1a). We attempted to remove the stent immediately using endobiliary biopsy forceps, a conventional snare, and a Dormia basket (●" Fig.2), as reported in various cases [1–4]; however these methods all failed because the pancreatic duct was of normal size and it was difficult to advance the devices past the neck of the pancreatic duct. Moreover, the curved pigtail head made capture impossible. The repeated attempts at removal only pushed the stent more deeply into the pancreatic duct. Consequently, we inserted a second 9cm-long pancreatic stent to prevent postERCP pancreatitis, removed the biliary stones, and then performed a laparoscopic cholecystectomy. Again, we tried to remove the migrated pancreatic stent, but failed despite trying various methods, Fig.1 Unintentionally migrated pigtail pancreatic stent in a 57-year-old man who underwent endoscopic retrograde cholangiopancreatography (ERCP) for multiple bile duct and gallbladder stones. a Unintentional deep inward migration of a pigtail pancreatic stent up to the neck of the normal pancreatic duct. b A second long pancreatic duct stent inserted to prevent post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis.