P1564 - A Novel Case of Biliary Stent Migration With Entrapment Within a Sigmoid Diverticulum

Many Americans suffer from gallbladder disease, from which 1% develop symptomatic gallbladder disease. Pancreaticobiliary obstruction is a rare complication of gallstone disease and can be life-threatening. Biliary stenting with plastic prostheses is the gold standard in biliary ductal obstruction. Patency for plastic stents (PS) is usually less than 4 months. Common complications of prolonged biliary stent retention include stent migration, pancreatitis, and obstruction of the biliary stent leading to cholangitis. Stents can become dislodged and pass through the GI tract spontaneously once they transverse the ileocecal valve. Here, we report a case of lower GI bleed due to plastic biliary stent dislodgement within a diverticulum five years post-placement.

A 72-year-old with a history of cholecystitis post laparoscopic cholecystectomy complicated by biliary leak with subsequent biliary stenting twice five years ago presented with a two-month history of functional decline and weight loss failure to thrive. His labs were significant for WBC 10.3, AST/ALT 153/94, ALP 703, total bilirubin 1.5, procalcitonin 2.24, CRP 190.3, ESR 64. He underwent CT abdomen which demonstrated 2 cm dilatation of the intrahepatic and extrahepatic bile ducts with stent visualization near the ampulla and the sigmoid lumen. The patient developed 3 episodes of hematochezia with symptomatic drop in hemoglobin from 14.6 to 9.0. He underwent a colonoscopy, revealing a dislodged stent with its pigtail entrapped in a sigmoid diverticulum. The stent was removed via rat-tooth forceps, allowing for hemostasis and resolution of the patient’s hematochezia.

There are 40 published cases involving foreign bodies and sigmoid diverticular disease. To our knowledge, only 10 cases presented with stent migration causing sigmoid diverticula entrapment or perforation. The persistence of a biliary PS for greater than 3-6 months significantly increases the risk of complication. We speculate this patient had recent stent dislodgement, leading to common bile duct occlusion and resultant cholangitis. After spontaneous passage through the ileocecal valve the stent likely dislodged in the sigmoid colon. This case underscores the importance of adhering to post-stenting follow-up. As time elapses, the risk, and severity of complication increases. Thus, every effort should be made to avoid loss of follow-up to obviate life-threatening and preventable complications of biliary stenting.