Biliary stent migration presenting as a recurrent pilonidal abscess with underlying rectocutaneous fistula

A 53-year-old patient was admitted to the gastroenterology department for the management of a benign biliary stricture secondary to chronic alcoholic pancreatitis. He underwent sphincterotomy and placement of a 10 Fr × 10 cm plastic biliary stent. Endoscopic follow-up 2 months later revealed spontaneous migration of the stent and no further intervention was performed.

The patient was admitted to the general surgery outpatient clinic 7 years later for the management of a recurrent pilonidal abscess. Excision of the abscess revealed a long fistulous track towards the coccyx with a plastic stent inside it ([Fig. 1 a, b]); the findings indicated a rectocutaneous fistula secondary to biliary stent migration. In addition, computed tomography scan showed a 1-cm defect of the sacro-coccygeal junction in contact with the rectum ([Fig. 2]). Postoperatively, the patient was treated with antibiotics and vacuum-assisted closure therapy and went on to make an excellent recovery. His follow-up over 4 years was unremarkable.

Fig. 1 The patient was admitted for management of a recurrent pilonidal abscess. a Excision of the pilonidal abscess revealed a fistulous track (arrowhead). b A 10 Fr × 10 cm plastic biliary stent was retrieved from the fistula.

Fig. 2 Postoperative computed tomography scan disclosed a 1-cm bone defect of the sacrococcygeal junction (arrowhead) in contact with the posterior wall of the rectum. The asterisk indicates the site of excision of the abscess.

Complications of stent placement are well known and include migration with fistula formation between a variety of organs, such as: duodenocolic fistula [1], duodenoscrotal fistula [2], enterosplenic fistula [3], enterocutaneous fistula [4], and colovaginal fistula [5]. However, to the best of our knowledge recurrent abscess secondary to a rectocutaneous fistula has not been described previously.

Endoscopy_UCTN_Code_CPL_1AK_2AI

Competing interests: None

• References

• 1 Ang BK, Wee SB, Kaushik SP et al. Duodenal-colic fistula resulting from migration of a biliary stent: a case report. Gastrointest Endosc 1998; 48: 80-83
• 2 Basile A, Macri’ A, Lamberto S et al. Duodenoscrotal fistula secondary to retroperitoneal migration of an endoscopically placed plastic biliary stent. Gastrointest Endosc 2003; 57: 136-138
• 3 Baccarani U, Risaliti A, Sainz-Barriga M et al. Ileosplenic fistula and splenic abscesses caused by migration of biliary stents in a liver transplant recipient. Gastrointest Endosc 2003; 58: 811-813
• 4 Karim A, Orbell JH, Bhatti K et al. Biliary stent migration presenting as a recurrent abdominal wall abscess with underlying enterocutaneous fistula. Gastrointest Endosc 2006; 63: 874-876
• 5 Blake AM, Monga N, Dunn EM. Biliary stent causing colovaginal fistula: case report. JSLS 2004; 8: 73-75