A devastating complication: duodenal perforation due to biliary stent migration.

Endoscopic retrograde cholangiopancreatography (ERCP) plays an important diagnostic and potentially therapeutic role in the management of a broad range of biliary and pancreatic disorders. However, it is an invasive procedure with an associated complication rate in the vicinity of 5% to 15% and mortality rate of 1%. We present an unusual case of a patient who sustained a stent-related duodenal perforation after undergoing ERCP. We reviewed the current literature in regard to risk factors, etiology, diagnosis, management, and prognosis of ERCP-related perforations, aiming to provide a brief, updated overview of this devastating complication.