Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report

Clinical Endoscopy
Jinwoo ChoiSeon Mee Park

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.

References

Mar 10, 2001·Cardiovascular and Interventional Radiology·J H LeeK W Kim
Dec 21, 2006·Diseases of the Colon and Rectum·David A LisleRoderick C Borrowdale
Dec 11, 2007·Cardiovascular and Interventional Radiology·Suraj J AmonkarJuan W Valle
Oct 18, 2008·Gastrointestinal Endoscopy·Sreeni Jonnalagadda, Riad Azar
Feb 26, 2009·The Kaohsiung Journal of Medical Sciences·Chiao-Hsiung ChuangHong-Ming Tsai
May 27, 2015·The British Journal of General Practice : the Journal of the Royal College of General Practitioners·Vinod S HegadeDavid E J Jones

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Citations

Nov 9, 2021·Asian Journal of Endoscopic Surgery·Sotaro FukuharaHideki Ohdan

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