Descending Colon Diverticulum Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent for Prophylaxis of Post-endoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis

Sep 30, 2026

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Post-ERCP pancreatitis (PEP) is a common and potentially serious complication after endoscopic retrograde cholangiopancreatography (ERCP), and prophylactic pancreatic spontaneous dislodgement stents (PSDSs) are used to reduce risk in high-risk patients. Migration-related adverse events are extremely rare, yet potentially life-threatening. This open access case report describes an 87-year-old man who developed fever and descending colon perforation 19 days after PSDS placement for PEP prophylaxis, confirmed by computed tomography and treated with laparoscopic exploration and partial colectomy with recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Abstract

Introduction

Case Presentation

Emergency ERCP and Stent Placement

Follow-up and Complications

How to Cite This Article

Review began 11/10/2025 Review ended 12/02/2025 Published 12/10/2025 © Copyright 2025 Naka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited. DOI: 10.7759/cureus.98923 Open Access Case Report Descending Colon Diverticulum Perforation Caused by Migration of a Pancreatic Spontaneous Dislodgement Stent for Prophylaxis of Postendoscopic Retrograde Cholangiopancreatography (ERCP) Pancreatitis Yutaro Naka 1, Takashi Goto 1 , Shimpei Uchida 2, Takanobu Sugase 1, Rintaro Koga 1 1. Surgery, Koga General Hospital, Miyazaki, JPN 2. Internal Medicine, Koga General Hospital, Miyazaki, JPN Corresponding author: Yutaro Naka, [yutaronaka112@gmail.com](yutaronaka112@gmail.com) Abstract Pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP), known as post-ERCP pancreatitis (PEP), is the most common and potentially serious complication of the procedure. Pancreatic spontaneous dislodgement stents (PSDSs) are widely used to reduce the incidence of PEP in high-risk patients. Although these stents are generally safe, migration-related complications such as intestinal perforation are extremely rare but potentially life-threatening. We present a case of descending colon perforation caused by migration of a PSDS placed for PEP prophylaxis. An 87-year-old man underwent ERCP for common bile duct stones, during which a 5 Fr, 3 cm straight-type PSDS was placed to prevent pancreatitis. Nineteen days later, he developed a fever, and computed tomography revealed perforation of the descending colon caused by the migrated stent. Laparoscopic exploration followed by open surgery confirmed the perforation and peritonitis. Partial colectomy with functional end-to-end anastomosis was performed, and the patient recovered without complications. This case highlights a rare but critical complication of PSDS use, particularly in patients with colonic diverticula or other anatomical variations. It emphasizes the importance of recognizing the risks associated with PSDS placement, conducting appropriate follow-up, ensuring early detection of complications, and facilitating timely intervention. Additionally, development and selection of safer stent designs may help reduce the risk of migration-related adverse events in the future. Categories: General Surgery, Radiology, Gastroenterology Keywords: colon diverticulum, colon perforation, endoscopic retrograde cholangiopancreatography, pancreatic spontaneous dislodgement stent, post-ercp pancreatitis (pep), stent migration Introduction Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common and potentially serious complication of ERCP. The prophylactic placement of a pancreatic spontaneous dislodgement stent (PSDS) is widely supported as an effective and safe strategy to reduce the incidence of PEP, particularly in high-risk patients, and its use has become increasingly common in recent years [1,2] . This strategy is also endorsed by Japanese and European guidelines [3,4] . PSDS devices are designed to spontaneously dislodge within a few days and transit through the gastrointestinal tract to be excreted in the stool. Because these stents migrate through the bowel, preexisting anatomical abnormalities may influence the risk of complications during their passage. Colon diverticula, which are common in elderly individuals, are known sites of gastrointestinal perforation and are reported to perforate more frequently than other colonic segments. However, serious complications such as intestinal perforation due to migration of these stents are rarely reported but can be life-threatening. We believe this to be the first reported case of colon diverticulum perforation caused by PSDS impaction. Herein, we describe the clinical cours

FAQs

What complication is most commonly associated with ERCP in this article?

Post-ERCP pancreatitis (PEP) is described as the most common and potentially serious complication after ERCP.

How is post-ERCP pancreatitis prophylaxis typically performed in high-risk patients?

The article states that prophylactic placement of a pancreatic spontaneous dislodgement stent (PSDS) is widely supported to reduce the incidence of PEP in high-risk patients.

What rare event did the patient experience after PSDS placement?

Nineteen days after PSDS placement, the patient developed fever, and computed tomography showed perforation of the descending colon caused by the migrated stent.

Sep 30, 2026

Uploaded by moss~