Acute cholangitis due to food reflux after self-expanding metal stent implantation without duodenal obstruction: A case report

Acute cholangitis has been reported as an uncommon adverse event after self-expandable metallic stent (SEMS) implantation. Herein, we report a case of an acute cholangitis caused by duodenal refluxate without duodenal obstruction. A 62-year-old woman received SEMS for an obstructive jaundice caused by a pancreatic head adenocarcinoma. She had been in stable condition until her percutaneous transhepatic cholangial drainage (PTCD) was clamped on the second postoperative day, and when a high fever and severe right epigastric pain developed. Fecal-impacted bowel loops were found through abdominal X-rays, and food contents were drained from PTCD afterward. Acute cholangitis caused by SEMS migration was initially suspected, and SEMS revision was performed two times, which did not improve the chymus reflux from PTCD. Metoclopramide was given after the second SEMS revision, and post-procedural upper gastrointestinal series with urografin shows no duodenal obstruction. No febrile event has been noted since the administration of metoclopramide. Acute cholangitis after SEMS implantation without duodenal obstruction could develop in patient with moderate to severe constipation. Prompt post-procedural prophylactic prokinetics for few days may prevent such episodes.