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Jeong, Kim, and Han: An unwonted complication of endoscopic retrograde cholangiopancreatography

Quiz

A 45-year-old man was admitted for the follow-up of benign biliary stricture after an episode of severe acute pancreatitis. He underwent endoscopic retrograde cholangiography (ERCP) three months prior. At that time, biliary sphincterotomy and stenting with a 10-Fr 7-cm stent (Cotton-Leung Biliary Stent; Cook Medical LLC, Bloomington, IN, USA) were performed, without complications. He had been abstinent from alcohol for the past eight months. He had no fever or abdominal pain. Abdominal examination showed a non-tender, flat abdomen. Complete blood count and liver function test results were all within normal ranges. Abdominal radiography revealed a biliary stent in the right upper quadrant (Fig. 1A). From abdominal computed tomography, the distal end of the biliary stent seemed to be slightly above the ampulla (Fig. 1B). ERCP was performed (Fig. 1C, D).
What is the most likely diagnosis?
 

NOTES

Conflicts of Interest
Jimin Han is currently serving as a CE Quiz Editor; however, Jimin Han was not involved in the peer reviewer selection, evaluation, or decision process of this manuscript. Han Taek Jeong and Ho Gak Kim have no potential conflicts of interest.
Funding
None.
Author Contributions
Conceptualization: HTJ, HGK, JH; Data curation: HTJ, HGK, JH; Investigation: HTJ, HGK, JH; Writing-original draft: JH; Writing-review & editing: HTJ, HGK, JH.

Fig. 1.
(A) Abdominal X-ray showed a biliary stent in the right upper quadrant. (B) Abdominal computed tomography revealed the biliary stent to be slightly above the ampulla (arrowhead). (C) Examination with the side-viewing duodenoscope showed evidence of prior sphincterotomy but no biliary stent at the bile duct orifice. (D) On fluoroscopy, the distal end of the biliary stent was located above the ampulla.
ce-2022-106f1.jpg
Fig. 2.
(A) A 0.035-inch guidewire was cannulated into the stent lumen. (B) A 7-Fr Soehendra stent retriever, which was placed over the guidewire, was screwed into the distal end of the stent. (C, D) Under endoscopic and fluoroscopic guidance, both the stent and the stent retriever were slowly pulled back into the duodenal lumen.
ce-2022-106f2.jpg

REFERENCES

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4. Calcara C, Broglia L, Comi G, et al. Plastic biliary stent migration during multiple stents placement and successful endoscopic removal using intra-stent balloon inflation technique: a case report and literature review. Am J Case Rep 2016;17:65–69.
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