Self-Expanding Metallic Stent Fracture in the Treatment of Malignant Biliary Obstruction

Figure 2

Complete stent fracture in an 81-year-old woman with common bile duct obstruction secondary to a cystic mass of the pancreatic head. (a). Percutaneous transhepatic cholangiogram depicting common bile duct stricture was shown. (b). Six weeks later, predilation (diameter, 8 mm; length, 40 mm; ATB5-35-40-8-4.0; COOK Inc.) was performed and a stent (diameter, 8 mm; length, 60 mm; COOK Inc., Bloomington, IN, United States) was inserted in the stricture, extending from the duodenum to the cystic duct. (c, d). Eleven months after biliary stent placement, the patient developed reobstructive jaundice, and percutaneous cholangiography showed stent occlusion. Two additional stents (diameter, 8 mm; length, 60 mm; COOK Inc., Bloomington, IN, United States) were deployed. An obtuse angle was formed distally between the two biliary stents (arrow). (e, f). Thirty-seven days after implantation of the two biliary stents, plain X-ray revealed the absence of the distal part of the stent (arrow), resulting from complete stent fracture. The fractured stent had therefore passed through the bowel without incident.

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