A previously healthy 52-year-old woman was referred for difficult choledocholithiasis, documented during open cholecystectomy with bile duct exploration and T-tube placement. At our hospital, she underwent endoscopic retrograde cholangiopancreatography (ERCP) with plastic stent placement (10 Fr x 12cm) and T-tube removal. The patient arrived at the emergency room with acute abdomen, 12h after the ERCP. During the approach, there were signs of systemic inflammatory response, and an abdominal computed tomography scan showed that the proximal end of the biliary stent was in the bile duct and the distal end was perforating the third part of the duodenum (Fig. 1). Upper gastrointestinal endoscopy corroborated the site of perforation by the endostent (Fig. 2). The patient underwent laparotomy with endostent extraction, primary closure of the duodenal perforation (Fig. 3), bile duct exploration with choledocholithiasis resolution, and verification through intraoperative cholangioscopy (Fig. 4). Duodenal perforations due to endostents are not considered in the Stapfer classification.1 Such perforations are rare (1%) and due to stent migration (which occurs in 8–10% of the cases).2 The majority of reported cases have involved stents larger than 10 Fr x 12cm.2,3 Treatment is endoscopic in the absence of peritonitis, or surgical in patients with retroperitoneal collections, sepsis, or peritonitis.1,2
The authors declare that no experiments were performed on humans or animals for this study.
Confidentiality of dataThe authors declare that they have treated all patient data with confidentiality and anonymity, following the protocols of their work center.
Right to privacy and informed consentThe authors declare that no patient data appear in this article.
Informed consent was not requested because the present article contains no personal data that enable the patient to be identified.
Financial disclosureNo financial support was received in relation to this study/article.
Conflict of interestThe authors declare that there is no conflict of interest.
The authors wish to thank Dr. Délano-Alonso for his contributions to the clinical case.
Please cite this article as: Trejo-Avila M, Valenzuela-Salazar C, Herrera-Esquivel JJ. Perforación duodenal por endoprótesis biliar. Revista de Gastroenterología de México. 2020;85:358–359.