Delayed-onset biliary peritonitis after endoscopic ultrasound-guided hepaticogastrostomy for malignant distal biliary obstruction

Endoscopic ultrasound-guided biliary drainage (EUS-BD) is performed when biliary drainage using endoscopic retrograde cholangiopancreatography (ERCP) is difficult [1] [2] [3] [4]. Biliary peritonitis is an adverse event that can be fatal; however, it typically develops immediately after the procedure [5]. Metallic stents reduce the risk of peritonitis. However, plastic stents are preferred for patients with benign diseases or who are surgical candidates. Herein, we present a case of peritonitis that developed 6 days after EUS-BD ([Video 1]).