Percutaneous retrieval of a biliary stent after migration and ileal perforation

Endoscopic biliary stent placement is a well established, safe and minimally invasive modality for the treatment of biliary diseases such as choledocholithiasis.[1,2] Over the past decade the use of this modality has increased in prevalence and utility. Despite the overall safety of this modality, on rare occasions these stents may migrate from the biliary tract.[3] A small percentage of those stents perforate the gut and require surgical intervention.[4,5] We present an unusual case of biliary stent migration with distal small bowel perforation and abscess formation which was successfully treated using interventional radiology techniques, including percutaneous drainage and fluoroscopic removal of the stent.A 76-year-old woman was admitted with cholecystitis and choledocholithiasis diagnosed via computed tomographic (CT) scan. Her past medical and surgical history was significant for paroxysmal atrial fibrillation, a right hemicolectomy and right oophorectomy for colon cancer, pulmonary embolism requiring inferior vena cava filter placement, endovascular abdominal aortic aneurysm repair, and a stroke resulting in vascular dementia. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy was performed with removal of an impacted common bile duct stone and placement of an uncoated 10F plastic endostent, though the duct was radiographically clear. Four days later, after her liver function test normalized, she underwent a laparoscopic cholecystectomy during which an intra-peritoneal abscess was found surrounding a markedly inflamed and necrotic appearing gallbladder. The cholecystectomy was performed without complication and the abscess was drained adequately. The remainder of her post-operative course was unremarkable and she was discharged home on post-operative day five.Approximately nine weeks after her laparoscopic cholecystectomy she presented to the emergency department complaining of four days of feculent emesis, intermittent diffuse abdominal