The forgotten biliary stent: an unusual cause of diarrhea.

This case highlights the possible complications of biliary stents, which may include migration and impaction in the gastrointestinal tract. It also emphasizes the need for a robust follow-up system after stent placement, to minimize the risks and possible sequelae of a forgotten stent.

A 79‐year‐old man presented to the colorectal clinic with abdominal pain, diarrhea, and weight loss over several months. Past history included obstructive jaundice secondary to gallstones impacted within the CBD 6 years previously, for which he had undergone ERCP with stent placement. Clinical examination revealed a palpable left iliac fossa mass.

Colonoscopy revealed an irregular, friable, obstructing growth within the sigmoid colon. CT demonstrated pneumobilia, and an inflammatory mass in the sigmoid colon containing the migrated stent (Figs 1, 2). Resection of the sigmoid colonic mass and primary anastomosis was performed. Histology confirmed active chronic inflammation secondary to the impacted biliary stent (Fig 3).

Figure 1

Coronal view of CT scan demonstrating pneumobilia as well as biliary stent impacted in sigmoid colon.

Figure 2

Axial view of biliary stent impacted within sigmoid colon inflammatory mass.

Figure 3

Resected specimen of sigmoid colon with biliary stent impacted within.

Temporary plastic biliary stents are placed for the management of malignant biliary obstruction, benign strictures, biliary leaks, and bile duct stones. Associated complications include stent occlusion, cholangitis, and distal migration, which may result in bowel obstruction, perforation, or fistula formation. The incidence of adverse events increases with prolonged stent indwelling time 2.

Currently, there are no guidelines for the maintenance of a biliary stent registry within UK endoscopy units. Although complications such as that highlighted in this case may be uncommon, the implementation of an electronic registry to prospectively track all stents may ensure timely follow‐up, and reduce the risk of stent‐related complications 1, 2, 3.

Conflict of Interest

None declared.