Metal stents are used to palliate advanced malignant gastric outlet and duodenal obstruction [1]
[2]. We present a rare complication due to a migrated duodenal stent, that highlights the need for a diagnosis of malignancy before deployment.
A 73-year-old man developed symptoms of gastric outlet obstruction following lumbar spine laminectomy at another institution. Computed tomography (CT) scanning revealed a mass lesion arising from the head of the pancreas compressing the second part of the duodenum. A presumptive diagnosis of carcinoma of the pancreas was made and an expanding metal stent was deployed without a histological diagnosis.
One month later he presented to our hospital with vague abdominal pain. A further CT scan showed free air and fluid within the peritoneal cavity and the pancreas looked normal. At laparotomy he was found to have a perforation where the metal stent had impacted in the distal ileum (Figure [1] and [2]). The pancreas felt normal. It was concluded that the pancreatic mass previously seen on CT scanning was inflammatory, and that as it resolved the stent had migrated. A small-bowel resection was performed. Following a good initial recovery the patient later developed cardiovascular instability from acute bacterial endocarditis (diagnosed on echocardiography) which was fatal. An autopsy was not performed as a cause of death had been identified.
Figure 1 Section of ileum showing perforation (stent removed).
Figure 2 Close up with stent in situ. The metallic stent had been placed endoscopically for gastric outlet obstruction secondary to a pancreatic lesion. The lesion was most probably inflammatory and when it resolved the stent migrated causing perforation of the distal ileum.
Duodenal perforation is a recognized complication associated with metal stents, both those in situ and migrated esophageal devices [3]
[4]
[5]. There have however been no reported cases of a duodenal stent migrating into the distal ileum and causing perforation. This case demonstrates the importance of a definitive diagnosis of malignancy before placing a stent for palliation.
Endoscopy_UCTN_Code_CPL_1AH_2AD
