Biliary stents deployed during endoscopic retrograde cholangiopancreatography (ERCP) are a well-established for the management of various biliary, hepatic or pancreatic diseases, both benign and malignant. Yet, their deployment should be entailed by routine stent exchange after 3 to 6 months. While stent migration is a relatively common complication with the incidence ranging from 5 to 10% (1), concurrent perforation of GI tract is a rare complication with the incidence of less than 1% (2). In general, such cases require urgent surgical intervention and further management depends on intraoperative findings (3). Though diagnosis itself is relatively easy, basing on routine imagining studies, one must keep in mind that further complications, for instance acute diffuse peritonitis or abscess formation is potentially life threatening, thus importance of proper management should be highlighted.

Aim of the study was analysis and literature review of less frequent complications such as large bowel perforation after biliary stent deployment due to hepatobiliary lesions.

All medical emergency cases of patients admitted to the Department of General and Transplant Surgery between 2011 and 2015 was analysed.

Analysis of the medical history and postoperative period was performed.

We have also performed review of the medical literature concerning that kind of complication using MEDLINE database.

During years 2011-2015 there were 7.162 emergency hospital admissions to the Department of General and Transplant Surgery in Norbert Barlicki Memorial Teaching Hospital. Out of that number we have selected 2 cases of migration of biliary prosthesis with concomitant perforation of distal part of the large bowel.

Analysis of the literature using MEDLINE revealed 23 cases of large bowel perforation caused by migrated biliary prosthesis. Mean age at the time of presentation was 70.5 years. Colon perforation mostly affected women (15 females vs. 10 males). Similarly, majority of reported patients had benign biliary lesion (20 vs. 5 malignant lesions). The most common cause of stent deployment was choledolithiasis, followed by postcholecystectomy bile leakage.

Herein we have described two selected patients’ medical cases admitted due to our department.

An 76-year-old female patient was admitted to the emergency department with a 3-day history of the umbilical and hypogastric regions pain. She negated any symptoms of intestinal obstruction. Otherwise, findings in physical examination were within normal range. She had underwent cholecystectomy 6 months earlier, following ERCP procedure with biliary stent deployment for choledocholithiasis. Due to lack of compliance the patient had omitted outpatient visits and the stent was left intact for 6 months. In the laboratory tests leukocytosis (15.81 x 10³), and elevation of AST (74 IU/L), ALT (42 IU/L), amylase (188 IU/L) were revealed. Afterwards, patient underwent abdominal RTG and CT which revealed presence of migrated biliary stent in left iliac fossa (fig. 1 and 2a-d). Umbilical hernia and diverticulitis were also found. Because of these findings, she was qualified for surgical treatment. She underwent laparotomy, during which biliary stent was found in sigmoid colon, in a diverticular ostium. Therefore subsequent sigmoideostomy was performed. As 500 ml of purulent fluid was present in the abdominal cavity, peritoneal lavage was also performed and fluid for smear was taken. Patient’s postoperative period was complicated with infectious diffuse peritonitis and after intensive antibiotic therapy she was discharged on 24^th postoperative day in a good condition.

An 68-year-old male patient presented with a 4-day history of the hypogastric region pain was admitted to our Department. He had underwent papillotomy with the deployment of 10 cm 7F biliary stent because of the cholestasis secondary to irresectable pancreatic head adenocarcinoma a month earlier. As for concomitant diseases he also had diabetes mellitus type 2 and osteoarthritis. Laboratory tests revealed hyperglycaemia (208 mg/dL), elevation of CRP (30.2 mg/dL) and amylase (172 IU/L). Similarly to the first case, biliary stent presence in rectum was confirmed by routine imagining studies. He also underwent urgent laparotomy, but since biliary stent was found in rectum, penetrating large bowel wall, transverse colostomy was performed. Peritoneal lavage and consecutive drainage were also made. He suffered from infectious diffuse peritonitis during his postoperative period and after antibiotic therapy he was discharged on 11^th postoperative day.