[Colovesicular fistula after migration of a biliary stent].

BACKGROUND

In 5% of endoscopically inserted biliary stents distal migration occurs. Mostly the endoprostheses pass the intestine spontaneously. In some patients the stent does not pass and causes complications such as perforation, fistulae and abscess formation.

CASE STUDY: A 76-year-old woman with choledocholithiasis received endoscopic retrograde cholangiopancreatography (ERCP). A stone was crushed and a plastic endoprosthesis inserted. After six months the patient returned with relapsing urinary tract infections. A CT scan showed the stent perforating the sigmoid and stuck in the bladder. The patient underwent sigmoid resection, the stent was removed from the bladder and the roof of the bladder was sutured over.

CONCLUSION

Bowel perforation and fistulae formation after migration of an endoscopically placed stent are rare but serious complications. Often symptoms of stent migration are not specific. When the diagnosis is made patients need to be carefully instructed and regularly inspected, especially patients with known risk factors such as adhesions, colonic diverticulae and abdominal hernias. If the stent does not pass spontaneously it has to be removed.