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Endoscopic management of a duodenal perforation secondary to a migrated biliary plastic stent.

A 57-year-old female was admitted to hospital for abdominal pain, weight loss and jaundice. Computed tomography revealed a Bismuth type IV hilar cholangiocarcinoma with distant metastases. An endoscopic retrograde cholangiopancreatography was performed and a plastic stent was placed to drain the left hepatic lobe. Five days after the procedure, the patient presented worsening of pain and fever. Abdominal CT scan showed a perforation of the third duodenal portion due to stent migration. Given the high morbidity and poor prognosis of the patient, we decided a conservative approach with endoscopic retrieval of the stent and closure of the perforation with 2 endoclips. She presented a favourable evolution and was discharged after the placement of a fully uncovered metal stent. She received palliative chemotherapy and died 6 months after the complication, due to progression of the malignant process. This case highlights the importance of rapid detection of this complication, which in selected cases can enable minimally invasive management. Endoscopic management is a feasible and safe approach in hemodynamically stable patients with small perforations. This could be useful in patients with malignancy or high comorbidities, who can exacerbate postoperative morbidities and increase mortality.