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Telescoping stents
TELESCOPING STENTS
A
B
C
D
A 61-year-old obese man with diabetes mellitus and sleep apnea presented with fever, jaundice, and right upper quadrant pain. At ERCP, a periampullary diverticulum (A) was noted, and purulent fluid was seen flowing from the papilla (A, arrows). Biliary cannulation proved to be difficult, and because the patient was critically ill with cholangitis, a 5 cm, 5F polyethylene pancreatic stent (with its inner flange shaved off) was placed to protect the pancreatic duct orifice. A biliary fistulotomy was then performed with a needle knife by using the stent as a guide. Retrograde cholangiography demonstrated an irregular cystic duct compatible with the diagnosis of cholecystitis; the bile ducts were not dilated. A 10 cm, 10F polyethylene stent was placed to ensure adequate drainage across the fistulotomy (B; P, pancreatic stent; B, biliary stent).
274
GASTROINTESTINAL ENDOSCOPY
Laparoscopic cholecystectomy was performed the next day and the patient had an uneventful recovery. Three weeks later, the pancreatic stent was visible in the right upper abdominal quadrant. Although the patient was asymptomatic, ERCP was performed to remove the pancreatic duct stent and thereby avoid changes in the pancreatic duct caused by the prolonged presence of the stent. At ERCP, the pancreatic stent had partially migrated through the distal side hole of the biliary stent and “telescoped” through its tip (C, D). The external flap on the pancreatic stent had prevented migration through the biliary stent. Both stents were grasped with a snare and removed. Andrew M. Axelrad, MD Reston, Virginia doi:10.1067/mge.2002.123910
VOLUME 56, NO. 2, 2002
A
B
C
D
A 61-year-old obese man with diabetes mellitus and sleep apnea presented with fever, jaundice, and right upper quadrant pain. At ERCP, a periampullary diverticulum (A) was noted, and purulent fluid was seen flowing from the papilla (A, arrows). Biliary cannulation proved to be difficult, and because the patient was critically ill with cholangitis, a 5 cm, 5F polyethylene pancreatic stent (with its inner flange shaved off) was placed to protect the pancreatic duct orifice. A biliary fistulotomy was then performed with a needle knife by using the stent as a guide. Retrograde cholangiography demonstrated an irregular cystic duct compatible with the diagnosis of cholecystitis; the bile ducts were not dilated. A 10 cm, 10F polyethylene stent was placed to ensure adequate drainage across the fistulotomy (B; P, pancreatic stent; B, biliary stent).
274
GASTROINTESTINAL ENDOSCOPY
Laparoscopic cholecystectomy was performed the next day and the patient had an uneventful recovery. Three weeks later, the pancreatic stent was visible in the right upper abdominal quadrant. Although the patient was asymptomatic, ERCP was performed to remove the pancreatic duct stent and thereby avoid changes in the pancreatic duct caused by the prolonged presence of the stent. At ERCP, the pancreatic stent had partially migrated through the distal side hole of the biliary stent and “telescoped” through its tip (C, D). The external flap on the pancreatic stent had prevented migration through the biliary stent. Both stents were grasped with a snare and removed. Andrew M. Axelrad, MD Reston, Virginia doi:10.1067/mge.2002.123910
VOLUME 56, NO. 2, 2002