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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

CT showing the biliary stent (red arrow) within the pericardial space and free pericardial fluid (blue arrow).
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Figure 3: CT showing the biliary stent (red arrow) within the pericardial space and free pericardial fluid (blue arrow).

Mentions: Twenty days following biliary stent insertion, he developed acute chest pain. An electrocardiogram showed widespread ST segment elevation; coronary angiography was normal. The following day, he developed a fever with dyspnea and supraventricular tachycardia. Chest radiography showed left lower lobe consolidation with air bronchograms and blunting of the left costophrenic angle. A biliary stent was noted on the inferior aspect of the film; its superior end was overlying the cardiac silhouette (Figure 2). He was treated with antibiotics for suspected pneumonia. A CT scan confirmed a large pericardial effusion, with the proximal tip of the plastic stent extending through the liver capsule and diaphragm into the pericardial sac (Figure 3). ERCP showed that the distal end of the stent was within the distal bile duct. The stent was mobilized with traction using a biliary extraction balloon and removed with stent grabbers. He remained hemodynamically stable during the procedure, but the pericardial effusion later enlarged and was successfully treated with percutaneous pericardial drainage of approximately 300 mL of blood.


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)

CT showing the biliary stent (red arrow) within the pericardial space and free pericardial fluid (blue arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: CT showing the biliary stent (red arrow) within the pericardial space and free pericardial fluid (blue arrow).
Mentions: Twenty days following biliary stent insertion, he developed acute chest pain. An electrocardiogram showed widespread ST segment elevation; coronary angiography was normal. The following day, he developed a fever with dyspnea and supraventricular tachycardia. Chest radiography showed left lower lobe consolidation with air bronchograms and blunting of the left costophrenic angle. A biliary stent was noted on the inferior aspect of the film; its superior end was overlying the cardiac silhouette (Figure 2). He was treated with antibiotics for suspected pneumonia. A CT scan confirmed a large pericardial effusion, with the proximal tip of the plastic stent extending through the liver capsule and diaphragm into the pericardial sac (Figure 3). ERCP showed that the distal end of the stent was within the distal bile duct. The stent was mobilized with traction using a biliary extraction balloon and removed with stent grabbers. He remained hemodynamically stable during the procedure, but the pericardial effusion later enlarged and was successfully treated with percutaneous pericardial drainage of approximately 300 mL of blood.

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