Retrograde migration of a fractured plastic biliary stent fragment after percutaneous displacement into the bowel in a patient with hepaticojejunostomy requiring repeat percutaneous retrieval

Biliary stent fragments are sometimes advanced into the bowel during percutaneous procedures with the expectation of spontaneous passage. We present a 67-year-old woman who underwent open left hepatectomy with en bloc resection of the common hepatic duct, Roux-en-Y hepaticojejunostomy, and cholecystectomy for hilar cholangiocarcinoma, and was subsequently found to have a retained fractured plastic biliary stent fragment within the intrahepatic bile ducts. During percutaneous transhepatic cholangiography (PTC), the fragment was captured with a snare and advanced into the small bowel, with the final cholangiogram confirming the fragment within the bowel. Surveillance imaging, however, demonstrated the fragment back within the intrahepatic bile ducts. It was definitively removed at a second PTC, after which an internal-external biliary drain was placed. The patient recovered well; the drain was later capped and removed at the bedside, and she remained asymptomatic with normal white-cell counts on follow-up. This case demonstrates that, in patients with hepaticojejunostomy, advancement of a stent fragment into the bowel may not be definitive, and that confirmatory imaging and consideration of complete retrieval are warranted.