Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc
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Case Report

Volume 5, Number 3, June 2012, pages 133-137

Late Migration of Covered Metal Stent to the Stomach Through a Spontaneous Choledochoduodenal Fistula in a Patient With Malignant Biliary Obstruction


Figure 1.
Figure 1. Abdominal CT revealed distal biliary obstruction, and a lesion approximately 3 cm diameter mass lesion located at the head of the pancreas at the first diagnosis (arrow).
Figure 2.
Figure 2. a: ERCP revealed an obstruction at the distal portion of the CBD. b: A partially covered WallFlex biliary stent was appropriately implanted in the CBD.
Figure 3.
Figure 3. a: Abdominal CT after 7 months of insertion of the metal stent revealed tumor growth in the pancreas and marked distension of the stomach and an obstruction of the descending part of the duodenum by the tumor (arrow). b: The SEMS was not present in the CBD (arrow).
Figure 4.
Figure 4. Abdominal CT showed the presence of the SEMS in the stomach (arrow).
Figure 5.
Figure 5. a: Duodenoscopy disclosed an obstruction of the descending part of the duodenum and a choledochoduodenal fistula at the proximal point of the duodenal obstruction. b: Cholangiogram was demonstrated by introducing contrast medium into the fistula.
Figure 6.
Figure 6. A duodenal WallFlex stent was inserted into the duodenum, and a fully covered WallFlex biliary stent was also inserted into the choledochoduodenal fistula, respectively.