Challenges in the management of acute lithiasic cholangitis due to a long-retained plastic biliary stent: A case report.

BACKGROUND AND IMPORTANCE: This case report focuses on a rare cause of acute lithiasis cholangitis, which is residual choledocholithiasis on a plastic biliary stent that was placed nine years prior.

CASE PRESENTATION: An 87-year-old male, with a history of hypertension and previous surgery for gallstone disease including cholecystectomy and placement of a Kehr drain in 2006, was diagnosed with residual stones in 2008 and received a plastic biliary stent after endoscopic sphincterotomy. Lost to follow-up for nine years, he presented with acute lithiasis cholangitis characterized by fever, conjunctival jaundice, leukocytosis, CRP elevation, and biochemical signs of cholestasis. CT imaging revealed choledocholithiasis on the biliary stent. The patient underwent surgical intervention, during which a dilated bile duct was discovered, a complete tangential choledocotomy was performed, and the stent/stone complex along with additional choledocholithiasis was removed. A choledochoduodenal anastomosis was subsequently performed.

DISCUSSION: The use of plastic biliary stents can paradoxically lead to the formation of biliary stones, a condition termed "stentolith". Such scenarios emphasize the complications arising from prolonged stent presence, including bacterial proliferation and the consequent formation of calcium bilirubin stones. While endoscopic removal of these stent-stone complexes has been successful in a few cases, surgical intervention is often required due to the risks associated with endoscopic extraction, such as potential duodenal perforation. The choice of lithotripsy technique for endotherapy depends on availability and patient-specific factors.

CONCLUSION: This complication highlights the importance of patient education, meticulous record-keeping, and regular follow-up to prevent such outcomes.