ERCP stent as a nidus for CBD stone: post cholecystectomy status

Authors

  • . Vinayaka Department of General Surgery, Rajarajeswari Medical College Hospital, Bangalore, Karnataka, India
  • S. J. Haridarshan Department of General Surgery, Rajarajeswari Medical College Hospital, Bangalore, Karnataka, India
  • Venkatesh S. Department of General Surgery, Rajarajeswari Medical College Hospital, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20175927

Keywords:

Common bile duct, ERCP, Nidus, Obstruction, Stent, Stones

Abstract

Obstruction of common bile duct due to a ‘Forgotten stent’ causing stone formation is a rare entity, which is usually associated with cholangitis. A much rarer presentation is our case with an ERCP stent forming a nidus for stone formation in the common bile duct without any evidence of cholangitis or bile duct obstruction.  A 66-year-old female patient with a previous history of laparoscopic cholecystectomy and common bile duct stenting done 2 years back presented with vague abdominal pain, nausea and vomiting without features of jaundice or cholangitis. She was diagnosed on imaging as a case of choledocholithiasis with two stents in the common bile duct. A failed ERCP to extract the stent and relieve obstruction necessitated open choledochotomy, stents removal, common bile duct clearance and choledochoduodenostomy. The rarity of this patient with an ERCP acting as a nidus for common bile duct stones without evidence of obstruction or cholangitis is something to be documented. Although rare, these complications must always be considered and considered a possibility due to which post-operative and post-endoscopic follow up, regular check-ups and timely removal of the stents is necessary to avoid unnecessary complications or a need for repeat procedures and surgery that results in greater morbidity.

References

Jablońska B, Lampe P. Iatrogenic bile duct injuries: Etiology, diagnosis and Management. World J Gastroenterol. 2009;15:4097-104.

Bruno M, Rauws E, Gouma, DJ. Use of removable covered expandable metal stents (RCEMS) in the treatment of benign distal common duct (CBD) strictures: a feasibility study [Abstract]. Gastrointest Endosc. 2005;61:AB.

Cahen DL, Rauws EA, Gouma DJ, Fockens P, Bruno MJ. Removable fully covered self-expandable metal stents in the treatment of common bile duct strictures due to chronic pancreatitis: a case series. Endoscopy. 2008;40:697-700.

Park do H, Lee SS, Lee TH, Ryu CH, Kim HJ, Seo DWet al. Anchoring flap versus flared end,fully covered self-expandable metal stents to prevent migration in patients with benign biliary strictures: a multicenter, prospective, comparative pilot study (with videos). Gastrointest Endosc. 2011;73:64-70.

Srinivasan I, Kahaleh M. Biliary stents in the millennium. Adv Ther. 2011;28:960-72.

Glenn F. Post cholecystectomy choledocholithiasis. Surg Gynecol Obstet. 1972;134:249-52.

Yu JL, Andersson R, Wang LQ, Ljungh A, Bengmark S. Experimental foreign-body infection in the biliary tract in rats. Scand J Gastroenterol. 1995;30:478-83.

Koivusalo A, Makisalo H, Talja M, Cormio L, Ruutu M, Wolff H, et al. incompatibility of latex and silicone T tubes in the porcine common bile duct: an experimental study. Res Exp Med (Berl). 1996;196:53-66.

Tiing LA, Kwong MF, Eng KT, Chua TS, Tan J. An audit of the outcome of long-term biliary stenting in the treatment of common bile duct stones in a general hospital. J Gastroenterol. 2006;41:765-7.

Ku MK, Lai KH, Lo GH, Cheng JS, Hsu PI, Lin CK et al. Long-term effect of large biliary endoprostheses in high-risk surgical patients with irretrievable common bile duct stones. Zhonghua Yi Xue Zazhi (Taipei). 1999;62:666-72.

Gong J, Sun X, Chen B. The evaluation of endoprostheses for the management of common bile duct occlusion by stones in elderly patients. Chin J Genatr. 2002;21:188-90.

Pisello F, Geraci G, Li Volsi F, Modica G, Sciumè C. Permanent stenting in ‘unextractable’ common bile duct stones in high risk patients. A prospective randomized study comparing two different stents. Langenbecks Arch Surg. 2008;393:857-63.

Downloads

Published

2017-12-26

Issue

Section

Case Reports