Mohammadi Tofigh Arash, Tahmasbi Hamed, Iranshahi Majid, Haghbin Toutounchi Alireza, Khoshnoudi Hojatolah, Kouchak Hosseini Seyed Pedram
Department of General Surgery, Imam Hosein Medical and Educational Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Gastroenterology and Liver Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Case Rep Surg. 2023 Aug 11;2023:9493333. doi: 10.1155/2023/9493333. eCollection 2023.
Endoscopic retrograde cholangiopancreatography (ERCP) is a non-surgical method utilized to manage biliary tract obstruction, but the complication of biliary stent migration occurs in 5-10% of patients. Though migrated stents are commonly passed through the gastrointestinal tract without harm, intestinal perforation is a rare but severe complication, affecting less than 1% of cases. We report a case of a 65-year-old woman who presented to the emergency department with symptoms of abdominal pain, nausea, and loss of appetite. According to clinical examination and evidence, the patient underwent surgery with high suspicion of appendicitis, which unexpectedly uncovered a perforated cecum with a protruding biliary stent. Our report describes a unique and unexpected finding of cecal perforation caused by a migrated biliary stent in a patient. We also conducted a review of current literature on ERCP complications, including risk factors for stent migration, relevant statistics, and appropriate interventions. Surgeons should be aware of the risk of stent migration and complications in patients with a history of ERCP. Removal of migrated biliary stents is recommended, regardless of the presence of complications. Additional assessments for alternative diagnoses are recommended for older patients with abdominal pain complaints. Flexible plastic stents should be used for patients at risk of stent passage.
内镜逆行胰胆管造影术（ERCP）是一种用于处理胆道梗阻的非手术方法，但胆道支架移位并发症发生在5%至10%的患者中。尽管移位的支架通常可无害地通过胃肠道，但肠穿孔是一种罕见但严重的并发症，发生率不到1%。我们报告一例65岁女性患者，因腹痛、恶心和食欲不振症状就诊于急诊科。根据临床检查和证据，该患者因高度怀疑阑尾炎而接受手术，结果意外发现盲肠穿孔并有一个突出的胆道支架。我们的报告描述了一例患者中由移位的胆道支架导致盲肠穿孔这一独特且意外的发现。我们还对当前关于ERCP并发症的文献进行了综述，包括支架移位的危险因素、相关统计数据以及适当的干预措施。外科医生应意识到有ERCP病史患者发生支架移位和并发症的风险。无论是否存在并发症，建议取出移位的胆道支架。对于有腹痛主诉的老年患者，建议进行其他诊断的额外评估。对于有支架通过风险的患者，应使用可弯曲塑料支架。
