Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report
- Author:
Jinwoo CHOI
1
;
Min Ji LEE
;
Hyodeok LEE
;
Yook KIM
;
Joung Ho HAN
;
Seon Mee PARK
Author Information
- Publication Type:Case Report
- Keywords: Pneumoperitoneum; Combined duodenal and biliary obstruction; Percutaneous transhepatic biliary drainage; Biliary stenting; Duodenal stenting
- MeSH: Aged, 80 and over; Bile; Drainage; Follow-Up Studies; Gastrointestinal Tract; Humans; Intestinal Perforation; Intestine, Small; Pneumoperitoneum; Stents; Urinary Bladder Neoplasms
- From:Clinical Endoscopy 2019;52(3):288-292
- CountryRepublic of Korea
- Language:English
- Abstract: Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.
