Pleural migration of biliary stent 10 years following treatment of hepatic hydatic echinococcosis: A case report

• Published in: International journal of surgery case reports Vol. 117; p. 109518
• Main Authors: Atri, S., Elaifia, R., Sebai, A., Hammami, M., Haddad, A., Kacem, J.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-04-2024; Elsevier
• Subjects: Biliary fistula; Biliary stent; Case Report; Endoscopy; Hydatic echinococcosis; Hydatic echinococcosis; Biliary fistula; Case report; Endoscopy; Biliary stent
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109518

Echinococcosis, caused by larval stages of taeniid cestodes, primarily affects the liver and is commonly treated surgically. However, a complication post-treatment is biliary fistula, necessitating interventions like biliary stents. While stent complications are recognized, proximal migration leading to pneumonia is exceptionally rare. This case report details an unusual occurrence of biliary stent migration years after hepatic hydatid echinococcosis treatment.
A 42-year-old patient underwent 2014 surgery for a large hydatid cyst, resulting in a biliary fistula. Endoscopic sphincterotomy and biliary stent placement led to a successful outcome. Lost to follow-up, the patient reappeared in 2022 with basithoracic pain, fever, and a thoracic CT scan revealing transdiaphragmatic stent migration causing basal pneumonitis. Antibiotic therapy and endoscopic stent removal ensued with an uncomplicated recovery.
This report emphasizes a rare complication that is proximal migration of a biliary stent 10 years post-initial placement for biliary fistula management. Despite the absence of typical risk factors. We managed a successful endoscopic retrieval. This highlights the importance of vigilance and follow-up for potential complications associated with biliary stent. Unusual presentations, like pneumonitis, underscore the need for awareness and a cautious approach.
The primary complication following surgical intervention for hepatic hydatid cysts is the development of an external biliary fistula, necessitating the use of biliary stents for treatment. Given the rarity of complications observed in our case, the removal of stents post-treatment for biliary fistula becomes crucial, underscoring the significance of vigilant follow-up care.
•Biliary stent are a widely used treatment for persistent biliary fistula.•Proximal migration is a rare complication of this procedure.•It usually occurs in patient with cholangiocarcinoma rarely for non-malignant disease such as hydatic echinococcosis.•Proximal migration causing a pneumonia is an extremely unusual complication.•Endoscopic management associated or no with surgery is the main treatment.