At the focal point| Volume 84, ISSUE 3, P542-543, September 2016

Esophageal migration of fractured gastroduodenal metal stent fragment in a patient with recurrent gallbladder carcinoma

Published:January 12, 2016DOI:
      A 62-year-old man with biliary and gastric outlet obstruction secondary to recurrent gallbladder carcinoma underwent bilateral internal biliary stent and self-expanding metal gastroduodenal stent placement. Four months later, the patient presented with gastric outlet obstruction and biliary obstruction. Thoracoabdominal CT and endoscopy were performed. Chest CT (A) demonstrated an oval metallic foreign body (arrow) consistent with a fractured proximal component of the gastroduodenal stent, which had migrated into the midesophagus. An endoscopic image (B) confirmed that the stent fragment was embedded within the midesophageal wall protruding into the lumen. A cropped frontal abdominal radiograph and a lateral chest radiograph (C and D) demonstrated the unwoven component of the stent in the gastric antrum (blue arrows) and the esophageal fragment (orange arrow). Stent fracture and nonpatency were confirmed endoscopically (E). Internal-external biliary drains were subsequently placed by an interventional radiologist. A percutaneous transgastric approach was used, and the fractured gastroduodenal stent was traversed with a Colapinto needle and wire. The internal biliary stents were snared and removed. The internal-external biliary drains were exchanged for a covered common bile duct stent for palliative biliary drainage. The patient also underwent palliative gastrojejunostomy for gastric outlet obstruction. The patient is currently tolerating soft solids, and the results of his biliary laboratory tests are stable.
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