Two forgotten guests: biliary and pancreatic stents retained after 14 years.

Abstract

We present a 54-year-old man with a previous complicated choledocholithiasis 14 years ago, treated with sphincterotomy and biliary and pancreatic stents placement by endoscopic retrograde cholangiopancreatography (ERCP). The patient didn't attend the follow-up. On this occasion, seeks medical attention at this medical center for abdominal pain, jaundice, and fever. Laboratory tests report leukocytosis with neutrophilia, elevated C reactive protein, and hyperbilirubinemia with cholestasis. An ERCP was performed and showed inflammatory ampullary tissue with a previous pancreatic and biliary stent in situ, both were removed succesfully with cold snare. Cholangiogram revealed a dilated bile duct and filling defects compatible with large stones. Due to the soft consistency of the stones, some of them were removed by balloon catheter without complete extraction, therefore a double pig-tail plastic stent was placed (Figure 2) and new ERCP in 4 weeks. The patient received antibiotic therapy with piperacillin-tazobactam with a favorable evolution. During follow-up, a new ERCP was performed with extraction of stones and removal of the stent; there was no evidence of secondary biliary cirrhosis.