Blake Anna-Maria, Monga Narinder, Dunn Ernest M
Department of General Surgery, Methodist Hospitals of Dallas, Texas 75203, USA.
JSLS. 2004 Jan-Mar;8(1):73-5.
Perforation of the bowel during placement of a biliary stent is a known complication of this procedure. We report the endoluminal loss of a biliary stent during routine stent extraction that ultimately led to a chronic colovaginal fistula. This case emphasizes the need for evaluation of fecal passage of stents in patients with a known dislodged prosthesis.
A 65-year-old white female underwent biliary stent placement for an episode of choledocholithiasis. The stent was lost in the duodenum during routine extraction. The patient was managed expectantly. She denied ever passing this stent via the rectum and began to develop symptoms of colovaginal fistula. Evaluation found a retained biliary stent in the sigmoid colon and a fistula into the vagina. The patient underwent elective low anterior resection and colovaginal fistula repair.
Reports exist of migration of stents that lead to acute colonic perforation and the need for emergent surgery. For this reason, it has been suggested that dropped or migrated stents be purposefully retrieved. However, if the option of expectant observation is used, it is important to clearly document the fecal passage of these stents and be prepared to retrieve these objects if they have a prolonged bowel transit time.
在放置胆道支架过程中肠道穿孔是该手术已知的并发症。我们报告了一例在常规支架取出过程中胆道支架腔内丢失，最终导致慢性结肠阴道瘘的病例。该病例强调了对于已知假体移位患者评估支架粪便排出情况的必要性。
一名65岁白人女性因胆总管结石发作接受了胆道支架置入术。在常规取出过程中，支架在十二指肠内丢失。患者接受了观察等待处理。她否认曾通过直肠排出该支架，并开始出现结肠阴道瘘的症状。评估发现乙状结肠内有一个残留的胆道支架以及一个通向阴道的瘘管。患者接受了择期低位前切除术和结肠阴道瘘修补术。
有报道称支架移位会导致急性结肠穿孔并需要紧急手术。因此，有人建议有意取出掉落或移位的支架。然而，如果采用观察等待的选择，重要的是清楚记录这些支架的粪便排出情况，并准备好在其肠道转运时间延长时取出这些物体。
