Retroperitoneal perforation of the duodenum from biliary stent erosion

George Miller, Duke Yim, Michael Macari, Marsha Harris, Peter Shamamian

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Endoscopically placed biliary stents have supplanted surgical decompression as the preferred treatment option for patients with obstructive jaundice from advanced pancreatic cancer. An unusual complication of indewelling biliary stents is duodenal perforation into the retroperitoneum. We describe the case of a patient with end-stage pancreatic cancer who presented with an acute abdomen from erosion of a previously placed bile duct stent through the wall of the second portion of the duodenum. Although our patient presented with advanced symptoms, clinical presentations can vary from mild abdominal discomfort and general malaise to overt septic shock. Definitive diagnosis is best made with computed tomography (CT) imaging, which can detect traces of retroperitoneal air and fluid. Treatment options vary from nonoperative management with antibiotics, bowel rest, and parenteral alimentation in the most stable patients to definitive surgery with complete diversion of gastric contents and biliary flow from the affected area in patients with clinical symptoms or radiologic evidence suggesting extensive contamination. Complications of management can include duodenal fistulization, residual retroperitoneal or intrabdominal abscess, and ongoing sepsis. This report highlights the salient issues in the presentation, diagnosis, and modern management of patients with this rare complication of indwelling biliary stents.

Original languageEnglish (US)
Pages (from-to)512-515
Number of pages4
JournalCurrent Surgery
Volume62
Issue number5
DOIs
StatePublished - Sep 2005
Externally publishedYes

Fingerprint

Duodenum
Stents
erosion
cancer
management
Pancreatic Neoplasms
environmental pollution
surgery
air
Surgical Decompression
Gastrointestinal Contents
Acute Abdomen
Obstructive Jaundice
Septic Shock
Bile Ducts
Abscess
evidence
Sepsis
Air
Tomography

Keywords

  • Biliary Stent
  • Duodenum
  • Intestinal Perforation
  • Pancreatic Cancer
  • Pyloric Exclusion

ASJC Scopus subject areas

  • Surgery

Cite this

Retroperitoneal perforation of the duodenum from biliary stent erosion. / Miller, George; Yim, Duke; Macari, Michael; Harris, Marsha; Shamamian, Peter.

In: Current Surgery, Vol. 62, No. 5, 09.2005, p. 512-515.

Research output: Contribution to journalArticle

Miller, George ; Yim, Duke ; Macari, Michael ; Harris, Marsha ; Shamamian, Peter. / Retroperitoneal perforation of the duodenum from biliary stent erosion. In: Current Surgery. 2005 ; Vol. 62, No. 5. pp. 512-515.
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