ENDOSCOPIC MANAGEMENT OF DUODENAL PERFORATION SECONDARY TO EARLY MIGRATION OF BILIARY PLASTIC STENT

Aims A 76-year-old woman with lung metastases and obstructive jaundice due to hilar cholangiocarcinoma was treated by a sphincterotomy and the insertion of a biliary plastic stent (BPS) (10F/12 cm). Two days later, she presented a duodenal perforation due to the displacement of the inserted BPS. In this context, therapeutic possibilities were valued (surgery or endoscopic treatment?)

Methods After discussing the case with the surgeon, it was decided to try closing the duodenal perforation by endoscopy. A distal cap was placed in the gastroscope tip. First, the plastic biliary stent was removed and then, the duodenal wall was closed with 3 clips. No duodenal contrast leak was noticed in Radiologic control. Finally, a self-expanding biliary stent was placed.

Results Steps: Removal of BPS/endoscopic closure of the duodenal wall (clips) using distal cap/Check for absence of duodenal leak/Placement of a self-expanding biliary stent.

Conclusions This endoscopic management allowed the duodenal perforation closure and the placement of a self-expanding biliary stent, with the resolution to both problems (perforation and jaundice), thus surgical intervention was avoided.