A repeat fluoroscopic contrast study of the drain showed resolution of the abscess GDC-0449 price and fistula. The drain was then removed without complication. Three months following drain removal, the patient was noted to be tolerating a regular diet with no signs of infection or fistula drainage. She suffered only mild deconditioning and had no significant loss of functional status. Figure 4 CT image of collapsed abscess cavity. CT image of the pelvis without contrast shows the drain in place and the abscess cavity completely collapsed. Discussion Migration of endoscopically placed biliary stents is a well recognized complication of ERCP. Less than 1% of migrated

stents cause intestinal perforation.[5] Of those that do perforate the bowel, the vast majority occur proximal to the ligament of Trietz (LOT). There have been a several case reports of intestinal perforation distal to the LOT, generally in the colon. [6–9] There have also been case reports describing small bowel perforation. [10–13] Generally speaking, a double pigtail stent (7F) is preferable in cases involving choledocholithiasis. A straight stent may migrate since there is nothing to hold it in place, even though there are side flaps. An exception might be an impacted stone that is tight on the stent and prevents migration. Dislodged straight stents are more likely to perforate

bowel whereas perforation with a pigtail is much more rare. Furthermore, straight 10 F plastic stents should generally be used for conditions such as strictures and tumours. The rationale IWP-2 mouse for a double pigtail stent (7F) in this case is not known to the authors. Migrated stents causing complications have either been retrieved endoscopically or via laparotomy.[4, 7, 14] There is at least one documented case of a percutaneous intervention to remove a biliary stent causing a selleck chemicals retroperitoneal duodenal perforation and bilioma. However, there has not been a documented case involving percutaneous methods to retrieve a migrated stent beyond the LOT. The

existing literature on this subject would advocate prompt and aggressive surgical intervention because of gross contamination, intraperitoneal abscess, Astemizole and bowel perforation.[4, 5] Prompt surgical intervention is generally indicated for small bowel perforations, especially in the setting of a highly contaminated field, bowel obstruction and generalized abdominal pain. Historically, bowel perforation from migrated bilary stents has been treated either by endoscopic retrieval or laparotomy should endoscopic means fail. There are reports in which endoscopy is used to retrieve stents and close bowel perforations via clip application, but this only applies to areas that are accessible to endoscopic instrumentation.[14] In our case, endoscopic means was not possible because the perforation was in the distal small bowel and associated with a partial small bowel obstruction.