Pancreatic stent migration-induced jejunal perforation following pancreaticoduodenectomy: case report and literature review

Background Jejunal perforation resulting from pancreatic stent migration represents a rare but potentially lethal complication after pancreaticoduodenectomy (PD), characterized by non-specific clinical manifestations. Clinicians must pay close attention to this postoperative adverse event. Standardized and precise intraoperative stent placement, combined with intensive postoperative surveillance and periodic follow-up, is essential to enable timely clinical intervention. Case presentation Two patients treated at our center underwent laparoscopic pancreaticoduodenectomy (LPD) for cholangiocarcinoma. On postoperative day 3 and day 6 respectively, both patients developed sudden severe abdominal pain along with fever and increased output from abdominal drains. Physical examination showed board-like abdominal rigidity, and imaging studies revealed abdominopelvic fluid collection. Emergency laparotomy confirmed jejunal perforation secondary to migrated pancreatic stents. The redundant segments of the stents were trimmed, followed by repair of the jejunal perforations. Both patients recovered uneventfully and were discharged smoothly. Conclusion Perforation secondary to internal pancreatic stents arises from multiple contributing factors. In the early postoperative phase, this complication is difficult to differentiate from anastomotic leakage. Unlike anastomotic leakage, however, stent-induced perforation rarely heals spontaneously, necessitating prompt accurate diagnosis and targeted intervention. For early-onset presentations, aggressive surgical intervention is recommended, whereas endoscopic management constitutes the first-line strategy for late-onset cases, with surgical repair undertaken as needed.