A case of colonic perforation from biliary stent.

ly used in benign biliary disease including postoperative bile leaks [1]. Occasionally, these stents may migrate distally, most passing spontaneously without causing problems. Perforation of the colon due to migrated stents is a very rare but reported complication. A 57−year−old lady was referred 3 days after a laparoscopic cholecystectomy with right hypochondrial pain. Blood tests revealed leucocytosis, normal biliru− bin but slightly raised alkaline phospha− tase, alanine transaminase, and gamma glutamyl transferase. Ultrasonography and computed tomography (CT) scan of the abdomen demonstrated a right sub− phrenic fluid collection, and magnetic resonance cholangiopancreatography (MRCP) suggested a retained stone in the common bile duct (l" Fig. 1). A laparo− scopic wash out and drainage was per− formed, draining 500 mL of bile, which ameliorated her symptoms. An endo− scopic retrograde cholangiopancreatog− raphy (ERCP) demonstrated small cystic duct leak but no retained stone. So a poly− ethylene 10−Fr 7 cm long biliary endo− prosthesis (Cotton±Leung, Wilson−Cook Medical Inc., Winston−Salem, North Caro− lina, USA) was inserted. Her condition im− proved, bile leak stopped, abdominal drain was removed, and she was dis− charged from hospital. She re−presented 4 weeks later with a 3− day history of abdominal pain and no bowel movement. She was pyrexial and had peritonism in the lower abdomen. The biliary stent was seen to be present in the lower abdomen on abdominal radiograph (l" Fig. 2). Laparotomy re− vealed perforated stent through a sig− moid diverticulum with minimal con− tamination (l" Fig. 3). The stent was re− moved and the perforation was closed with a covering loop transverse colos− tomy. Her postoperative recovery was un− remarkable, and 2 months later she un− derwent an uneventful sigmoid colec− tomy and closure of the colostomy. Only nine other cases of colonic perfora− tion (five free perforation in the perito− neum, one through the cecal diverticu− lum with localised abscess, and three to the adjacent organ or fistulating through the skin) have been reported [2 ±5]. (Not all references cited due to lack of space.) Stent perforation should be considered in a patient presenting with abdominal pain and peritonism following placement of a biliary endoprosthesis. Stents should al− ways be removed following an exchange procedure to prevent risk of perforation.