A biliary stent is placed to decompress biliary obstruction and to allow the flow of bile into the duodenum. If the stent becomes displaced it may pass harmlessly, or else it may cause a bowel perforation.
Patient selection: history of biliary obstruction and placement of a biliary stent
A plastic stent tends to migrate more often.
Clinical features:
(1) The patient develops signs of bowel perforation (abdominal pain, fever, peritonitis).
(2) A biliary stent is found at the site of perforation or within the peritoneal cavity.
(3) The dimensions of the perforation correspond to the dimensions of the stent.
(4) No other explanation for the perforation is identified.
Common sites of perforation:
(1) diverticulum
(2) bowel held by adhesions
(3) bowel within an abdominal wall or umbilical hernia
(4) retroperitoneal colon segments
If the bowel perforation is small and there is no sign of peritonitis, then endoscopic removal of the stent can be attempted with the wall defect closed by endoscopically-placed clips. More significant perforations require surgical repair.
