Abstract

TOVAR F, Germán; MENDOZA S, Jairo; VELANDIA C, Carlos  and  LOPEZ L, Carlos. Case Report of Rescue Therapy for Bile Duct Perforation using Fully Covered Self-Expanding Metal Stent after Failure of Conservative Management. Rev Col Gastroenterol [online]. 2018, vol.33, n.1, pp.74-79. ISSN 0120-9957.  https://doi.org/10.22516/25007440.235.

Complications occur in 5% to 10% of patients who undergo endoscopic retrograde cholangiopancreatography (ERCP), but less than 1% suffer perforations. The use of fully covered self-expanding metal stents (SEMS) to close uncomplicated perforations has become a safe optional strategy for initial management of these patients, as well as for rescue therapy when conservative management has failed.

We present the case of a 73-year-old patient with residual choledocholithiasis who underwent therapeutic ERCP with sphincterotomy and stone removal. Twelve hours after the intervention, the patient returned to the emergency department where a biliary tract type II perforation secondary to sphincterotomy was confirmed. Subsequent conservative management included suspension of oral feeding, administration of proton pump inhibitors and antibiotics, surgical evaluation and medical observation. Failure of non-surgical management led to consideration of placement of a fully covered SEMS as rescue therapy. The patient’s postoperative evolution was with satisfactory, and she was discharged eight days after stent placement.

Keywords : Biliary tract; intestinal perforation; endoscopic retrograde cholangiopancreatography; postoperative.

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