Removal of a migrated biliary stent perforating the colonic wall: a case description of endoscopic repair
Bibliographic record
Abstract
Endoscopically placed biliary stents are commonly used for the treatment of pancreaticobiliary disorders. Plastic biliary stent migration is a complication that occurs in 6 % – 7.5 % of cases [ 1 ]. Perforation of the gastrointestinal tract secondary to stent migration is a rare event, occurring in less than 1 % of cases. Reported cases of this complication have required surgery for stent removal and repair. This is a case report of a migrated biliary stent causing a perforation that was managed endoscopically. A 90-year-old woman with recurrent biliary obstruction secondary to gallstones and Mirizzi’s syndrome was being managed with sequential biliary stent exchanges. The patient presented to hospital with a sudden onset of severe abdominal pain, fevers, and rigors. On physical examination, her abdomen was tender in the right upper quadrant. An abdominal computed tomography (CT) scan identified a migrated biliary stent in the ascending colon, one end of which was perforating the colonic wall, with evidence of surrounding fat stranding but no intraperitoneal free air ([ Fig. 1 ]). Fig. 1 Computed tomography (CT) scan images showing a biliary stent passing through the colonic wall in the ascending colon in: a sagittal; b coronal; and c axial view. The patient was admitted for treatment with intravenous antibiotics and observation. In view of the patient’s multiple comorbidities and her own preference, an attempt at endoscopic management was undertaken, with surgical management reserved in case of failure. The stent was successfully removed, and the defect was repaired with endoscopic clips and an endoloop ([ Video 1 ]; [ Fig. 2 ]). The patient did well and was subsequently sent home on a course of oral antibiotics. Video 1 The stent was removed from the wall of the ascending colon using a snare. The defect was closed with three clips, and an endoloop to approximate the mucosa. Quality: mobile 360 480 720 Download Fig. 2 Endoscopic views showing: a the impacted biliary stent passing through the colonic wall; b the colonic perforation after closure using three hemostatic clips and an endoloop. The efficacy of repair for perforations using hemostatic clips is limited by the clip size, and the amount of pressure each clip can apply across a defect [ 2 ]. As such, using an endoloop around the clips reinforces and further stabilizes the closure. The technique is analogous to a purse-string suture. This case and accompanying video illustrate the benefits of endoscopic closure of a perforation, with avoidance of surgery and accelerated recovery. Endoscopy_UCTN_Code_CPL_1AK_2AI Endoscopy E-Videos https://eref.thieme.de/e-videos Endoscopy E-Videos is a free access online section, reporting on interesting cases and new techniques in gastroenterological endoscopy. All papers include a high quality video and all contributions are freely accessible online. This section has its own submission website at https://mc.manuscriptcentral.com/e-videos
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.004 | 0.003 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.005 | 0.003 |
| Science and technology studies | 0.004 | 0.003 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.003 |
| Research integrity | 0.012 | 0.005 |
| Insufficient payload (model declined to judge) | 0.003 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".