Endoscopy 2021; 53(07): E271-E272
DOI: 10.1055/a-1261-2863
E-Videos

Food impaction mimicking dislodgment of a lumen-apposing metal stent in a patient undergoing endoscopic ultrasound-guided gallbladder drainage for acute cholecystitis

Fabio De Vincentis
Azienda Unità Sanitaria Locale della Romagna, Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
,
Omero Triossi
Azienda Unità Sanitaria Locale della Romagna, Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
,
Mario Brancaccio
Azienda Unità Sanitaria Locale della Romagna, Gastroenterology Unit, Santa Maria delle Croci Hospital, Ravenna, Italy
› Author Affiliations
 

A 77-year-old woman who was unsuitable for surgery underwent endoscopic ultrasound-guided gallbladder drainage (EUS-GBD) using a lumen-apposing metal stent (LAMS) for acute cholecystitis. Her clinical history included lung adenocarcinoma and a recent development of pulmonary embolism. Chronic medication included immunotherapy and low molecular weight heparin. She was admitted again with a complaint of pain in the right hypochondrium and hyperpyrexia about 2 weeks after the procedure.

Initially, a computed tomography (CT) scan showed that the LAMS had dislodged into the gastric cavity, and an intraperitoneal fluid collection with air bubbles extended for about 35 cm between the stomach and the gallbladder ([Fig. 1]). EUS showed the LAMS to be in place but obstructed by food residue, which was removed with a snare ([Fig. 2, ] [Video 1]).

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Fig. 1 Computed tomography scan showed the dislodged lumen-apposing metal stent in the gastric cavity and intraperitoneal fluid collection with air bubbles between the stomach and the gallbladder.
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Fig. 2 Endoscopic ultrasound showed the lumen-apposing metal stent to be in place but obstructed by food impaction, which was removed with a snare.

Video 1 Suspected dislodgment of a lumen-apposing metal stent (LAMS) was in fact an obstruction due to food impaction. After endoscopic debridement, a plastic pigtail stent was placed through the LAMS to prevent future occlusions.


Quality:

After injection of contrast medium into the gallbladder through the stent, fluoroscopy excluded leakage ([Fig. 3]). A plastic pigtail stent was placed through the LAMS to prevent future occlusions ([Fig. 4]).

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Fig. 3 Fluoroscopy showed no leakage of contrast medium.
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Fig. 4 Fluoroscopic image of pigtail stent placement through the lumen-apposing metal stent.

CT scan following contrast administration through the nasogastric tube showed outcomes of gallbladder drainage, with the LAMS in place and the distal ends of the pigtail stent in the gastric and gallbladder cavities, and no leakage of contrast medium ([Fig. 5]). The patient’s symptoms subsequently resolved.

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Fig. 5 Computed tomography scan following administration of contrast showed the lumen-apposing metal stent in place, and the distal ends of the pigtail stent in the gastric and gallbladder cavities. No leakage of contrast medium was seen.

Stent occlusion (secondary to food bolus, gallstones, clots, or tissue overgrowth over time) is a post-procedural complication of EUS-GBD that sometimes (as in our case) can mimic more complex clinical and radiological pictures. It can be managed with endoscopic debridement and with placement of a pigtail stent through the LAMS. 

Prophylactic placement of pigtail stents at the time of the initial procedure has been proposed to prevent this complication, particularly in patients where the stent is intended to remain in situ indefinitely [1].

Endoscopy_UCTN_Code_CPL_1AL_2AD

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Competing interests

The authors declare that they have no conflict of interest.


Corresponding author

Fabio De Vincentis, MD
Gastroenterology Unit
Santa Maria delle Croci Hospital
Viale Vincenzo Randi 5
48121 Ravenna
Italy   
Fax: +39-0544-285325   

Publication History

Publication Date:
01 October 2020 (online)

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany


Zoom Image
Fig. 1 Computed tomography scan showed the dislodged lumen-apposing metal stent in the gastric cavity and intraperitoneal fluid collection with air bubbles between the stomach and the gallbladder.
Zoom Image
Fig. 2 Endoscopic ultrasound showed the lumen-apposing metal stent to be in place but obstructed by food impaction, which was removed with a snare.
Zoom Image
Fig. 3 Fluoroscopy showed no leakage of contrast medium.
Zoom Image
Fig. 4 Fluoroscopic image of pigtail stent placement through the lumen-apposing metal stent.
Zoom Image
Fig. 5 Computed tomography scan following administration of contrast showed the lumen-apposing metal stent in place, and the distal ends of the pigtail stent in the gastric and gallbladder cavities. No leakage of contrast medium was seen.