Asymptomatic duodenal perforation from obstructed and migrated biliary stent.

principal management option in the treatment of pancreaticobiliary disease. Longterm complications include occlusion, migration, and dislocation [1–3]. Duodenal perforations caused during stent migration are rare but life-threatening [4], with complications including peritonitis, sepsis, retroperitoneal abscess, and duodenal fistulization [4–5]. This report describes an asymptomatic case of duodenal perforation caused by distal stent migration and successful retrieval of the migrated stent using an endoscope. A 70-year-old man with a short history of jaundice underwent placement of an 8.5-Fr biliary stent for drainage at a local hospital. Meanwhile cholangiographydisclosed evidence of hepatic portal filling defects. Several days later he underwent laparotomy, during which the biliary stent was neither found nor extracted. Frozen section detection did not show malignant tumor cell. Cholecystectomywas thenperformed, and a T-tube was placed in the common bile duct (CBD). The patient made a good recovery. Twenty days later, T-tube tract cholangiographyand computed tomography (CT) scan revealed the distal end of the biliary stent located 10mm into the duodenal lumen (●" Fig. 1). This patient presented without any symptomsof stent perforationor gallstonesduring a 2-year period. More recently, he was admitted to our department to determine whether or not the stent hadmigrated. Under endoscopy, the distal part of the stent was found to penetrate the contralateral bowel wall of the duodenal papilla (●" Fig. 2). The proximal stent was in the CBD. The stent was retrieved using a rat tooth grasping forceps and found to be obstructed. The perforation wound was clamped with a hemostatic clip (●" Figs. 3–5). Cholangiography disclosed severe filling defects in the CBD (●" Fig. 6). The stones were retrieved with a wireguided basket. In this case, the stent was obstructed before migration, so the bile could not evacAsymptomatic duodenal perforation from obstructed and migrated biliary stent