Secondary iatrogenic duedonum perforation: a rare complication

Abstract

The incidence of perforations resulting from Endoscopic Retrograde Cholangiography (ERCP) is observed to be less than 1%. In this case report, we aim to present our unique experience as a mechanism, which is even more uncommon. A 68-year-old male with an ASA score of 2 was prediagnosed with a distal common bile duct tumor. ERCP was performed for therapeutic and diagnostic purposes and a 9F 10 cm plastic stent was placed to relieve obstruction. The patient, who had the sudden onset of abdominal pain within the initial 24-hour period following the procedure, underwent surgical intervention subsequent to a computed tomography assessment. In the third portion of the duodenum, an approximately 4 mm perforation originating from the stent was observed during the examination. It was repaired with a 3.0 prolene suture, followed by omentopexy. He was discharged uneventfully on the eighth day. Although duodenal perforation due to the placement of a plastic biliary stent with ERCP is a very uncommon complication, the patient's clinical and imaging findings are essential for treatment planning.

Keywords

• Endoscopic retrograde cholangiography
• biliary stent
• duedonum
• perforation
• complication

References

1. 1. Alghsoon SA, Shaban KS, Khan AH, et al. A comparison of radiation exposure during endoscopic retrograde cholangiopancreatography (ERCP) by different fluoroscope techniques. Innov Surg Interv Med. 2020;1(1):9-14. doi: 10.36401/ISIM-20-02.
2. 2. Mallery JS, Baron TH, Dominitz JA, et al. Complications of ERCP. Gastrointest Endosc. 2003;57(6):633-638. doi: 10.1053/ge.2003.v57.amge030576633.
3. 3. Solomon S, Baillie J. 7 - Indications for and contraindications to ERCP. In: Baron TH, Kozarek RA, Carr-Locke DL, eds., ERCP. 3rd ed., Philadelphia: Elsevier; 2019: pp. 54-58.e51.
4. 4. Talukdar R. Complications of ERCP. Best Pract Res Clin Gastroenterol. 2016;30(5):793-805. doi: 10.1016/j.bpg.2016.10.007.
5. 5. Ida Bagus B. A rare clinical presentation of third part duodenal perforation due to post-endoscopic retrograde cholangiopancreatography stent migration on advanced stage peri-ampullary tumor. JGH Open. 2021;5(8):968-970. doi: 10.1002/jgh3.12608.
6. 6. Mousa HM, Hefny AF, Abu-Zidan FM. Life-threatening duodenal perforation complicating endoscopic retrograde cholangiopanceatography: a case series. Int J Surg Case Rep. 2020;66:404-407. doi: 10.1016/j.ijscr.2020.01.001.
7. 7. Langerth A, Isaksson B, Karlson BM, Urdzik J, Linder S. ERCP-related perforations: a population-based study of incidence, mortality, and risk factors. Surg Endosc. 2020;34(5):1939-1947. doi: 10.1007/s00464-019-06966-w.
8. 8. Fujii Y, Matsumoto K, Miyamoto K, et al. Endoscopic treatment for duodenal perforation due to biliary stent dislocation: a case report and brief review of the literature. Medicine (Baltimore). 2022;101(48):e31868. doi: 10.1097/MD.0000000000031868.

9. 9. Prachayakul V, Aswakul P. Endoscopic retrograde cholangiopancreatography-related perforation: Management and prevention. World J Clin Cases. 2014;2(10):522-527. doi: 10.12998/wjcc.v2.i10.522.
10. 10. Bozbiyik O, Cetin B, Gumus T, Tekin F, Uguz A. Fully covered self-expandable metal stent for intraprocedural or late-diagnosed Type-II endoscopic retrograde cholangiopancreatography-related perforations. BMC Gastroenterol. 2022;22(1):385. doi: 10.1186/s12876-022-02466-9.
11. 11. Kumbhari V, Sinha A, Reddy A, et al. Algorithm for the management of ERCP-related perforations. Gastrointest Endosc. 2016;83(5):934-43. doi: 10.1016/j.gie.2015.09.039.
12. 12. Yuan XL, Ye LS, Liu Q, et al. Risk factors for distal migration of biliary plastic stents and related duodenal injury. Surg Endosc. 2020;34(4):1722-1728. doi: 10.1007/s00464-019-06957-x.
13. 13. Johanson JF, Schmalz MJ, Geenen JE. Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc. 1992;38(3):341-346. doi: 10.1016/s0016-5107(92)70429-5.
14. 14. Arhan M, Odemiş B, Parlak E, Ertuğrul I, Başar O. Migration of biliary plastic stents: experience of a tertiary center. Surg Endosc. 2009;23(4):769-775. doi: 10.1007/s00464-008-0067-x.