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Pericardiobiliary Fistulation: A Rare Complication of Therapeutic ERCP in a Patient With IgG4-Related Sclerosing Cholangitis.

Paranandi B, Joshi D, Johnson GJ, Webster GJ - ACG Case Rep J (2015)

Bottom Line: Imaging demonstrated haemopericardium due to proximal migration of the plastic biliary stent through the liver capsule and diaphragm into the pericardial sac.The stent was endoscopically removed and a pericardiocentesis was performed.The patient's clinical condition rapidly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Pancreaticobiliary Medicine, University College London Hospitals, London, United Kingdom.

ABSTRACT
A 70-year-old man presented with acute coronary syndrome 3 weeks after plastic stent insertion for hilar biliary stricturing secondary to IgG4-related sclerosing cholangitis (IgG4-SC). Imaging demonstrated haemopericardium due to proximal migration of the plastic biliary stent through the liver capsule and diaphragm into the pericardial sac. The stent was endoscopically removed and a pericardiocentesis was performed. The patient's clinical condition rapidly improved. We illustrate an unusual but potentially serious complication that may arise from migration of a biliary stent and discuss a management strategy.

No MeSH data available.


Related in: MedlinePlus

ERCP showing (A) a cholangiogram with areas of biliary structuring at the liver hilum (red arrow) and distal common bile duct (blue arrow), (B) a pancreatogram with a thin, irregular main pancreatic duct (arrow) in the head/body of pancreas with some relative dilation towards the tail, and (C) the 15-cm, 10-French straight biliary stent (arrow) sited across the hilum into the left main intrahepatic duct.
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Figure 1: ERCP showing (A) a cholangiogram with areas of biliary structuring at the liver hilum (red arrow) and distal common bile duct (blue arrow), (B) a pancreatogram with a thin, irregular main pancreatic duct (arrow) in the head/body of pancreas with some relative dilation towards the tail, and (C) the 15-cm, 10-French straight biliary stent (arrow) sited across the hilum into the left main intrahepatic duct.

Mentions: He started a tapering course of oral steroids and had an excellent biochemical and clinical response. His biliary stent was removed. After 6 months, steroid treatment was stopped. Three months later, he presented with jaundice and chills. Repeat ERCP demonstrated 2 short, dominant biliary strictures in the distal CBD and at the liver hilum (Figure 1), and a long, irregular, thin pancreatic duct (Figure 1). A 15-cm, 10-French, straight plastic biliary stent was placed across the liver hilum into the left main intrahepatic duct (Figure 1). The length of this stent was necessary to traverse both strictures and provide adequate biliary drainage. Steroids were restarted with intent of starting second-line long-term maintenance immunosuppression.


Pericardiobiliary Fistulation: A Rare Complication of Therapeutic ERCP in a Patient With IgG4-Related Sclerosing Cholangitis.

Paranandi B, Joshi D, Johnson GJ, Webster GJ - ACG Case Rep J (2015)

ERCP showing (A) a cholangiogram with areas of biliary structuring at the liver hilum (red arrow) and distal common bile duct (blue arrow), (B) a pancreatogram with a thin, irregular main pancreatic duct (arrow) in the head/body of pancreas with some relative dilation towards the tail, and (C) the 15-cm, 10-French straight biliary stent (arrow) sited across the hilum into the left main intrahepatic duct.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508954&req=5

Figure 1: ERCP showing (A) a cholangiogram with areas of biliary structuring at the liver hilum (red arrow) and distal common bile duct (blue arrow), (B) a pancreatogram with a thin, irregular main pancreatic duct (arrow) in the head/body of pancreas with some relative dilation towards the tail, and (C) the 15-cm, 10-French straight biliary stent (arrow) sited across the hilum into the left main intrahepatic duct.
Mentions: He started a tapering course of oral steroids and had an excellent biochemical and clinical response. His biliary stent was removed. After 6 months, steroid treatment was stopped. Three months later, he presented with jaundice and chills. Repeat ERCP demonstrated 2 short, dominant biliary strictures in the distal CBD and at the liver hilum (Figure 1), and a long, irregular, thin pancreatic duct (Figure 1). A 15-cm, 10-French, straight plastic biliary stent was placed across the liver hilum into the left main intrahepatic duct (Figure 1). The length of this stent was necessary to traverse both strictures and provide adequate biliary drainage. Steroids were restarted with intent of starting second-line long-term maintenance immunosuppression.

Bottom Line: Imaging demonstrated haemopericardium due to proximal migration of the plastic biliary stent through the liver capsule and diaphragm into the pericardial sac.The stent was endoscopically removed and a pericardiocentesis was performed.The patient's clinical condition rapidly improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Pancreaticobiliary Medicine, University College London Hospitals, London, United Kingdom.

ABSTRACT
A 70-year-old man presented with acute coronary syndrome 3 weeks after plastic stent insertion for hilar biliary stricturing secondary to IgG4-related sclerosing cholangitis (IgG4-SC). Imaging demonstrated haemopericardium due to proximal migration of the plastic biliary stent through the liver capsule and diaphragm into the pericardial sac. The stent was endoscopically removed and a pericardiocentesis was performed. The patient's clinical condition rapidly improved. We illustrate an unusual but potentially serious complication that may arise from migration of a biliary stent and discuss a management strategy.

No MeSH data available.


Related in: MedlinePlus