Rescue surgery for intra-abdominal migration of plastic stentsin endoscopic ultrasound-guided hepaticogastrostomy

Sep 30, 2026

Rescue surgery was performed for rare intra-abdominal migration of endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS) plastic stents. A 91-year-old man with obstructive jaundice after prior stomach-partitioning gastrojejunostomy developed migration, with imaging suggesting the gastric side entered the abdominal cavity while the stent tip remained in the bile duct. Emergency surgery repositioned the migrated stent into the stomach, created and managed a new fistula for biliary drainage, and promoted fistula formation with targeted suturing. Obstructive jaundice resolved and recurrence was later treated successfully by endoscopic stent exchange.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Case overview

Imaging and diagnosis

Emergency surgery and stent repositioning

Clinical outcome and follow-up

Article published online: 2026-01-08 Rescue surgery for intra-abdominal migration of plastic stentsin endoscopic ultrasound-guided hepaticogastrostomy Plastic stents (PSs; Type IT, Gadelius Medical K. K., Tokyo, Japan), designed specifically for endoscopic ultrasound-guided hepaticogastrostomy (EUS-HGS), feature a pigtail shape on the gastric side, and migration into the abdominal cavity is particularly rare [1,2] . We experienced a case of intra-abdominal migration of a dedicated PS during EUS-HGS and successfully performed biliary drainage by returning the migrated PSto the stomach through emergency surgery. The patient was a 91-year-old man, who had previously undergone stomach-partitioning gastrojejunostomy ( ▶ Fig.1) [3] for duodenal cancer. EUS-HGS was performed to treat obstructive jaundice. Due to the suturing of lesser curvature, endoscopic visualization was not possible. Therefore, the PS was deployed under fluoroscopic guidance. The stent was not visible in the stomach, suggesting intraabdominal migration. Computed tomography confirmed that the tip remained in the bile duct, while the gastric side had entered the abdominal cavity. Emergency surgery was performed. The migrated stent was confirmed intraoperatively. The original puncture site had closed naturally, a new fistula site was thus created at the position where the PS was stretched straight. A purse-string suture (3–0 Vicryl, Ethicon, Inc. , New Jersey, USA) was placed, and the stomach was opened using mosquito forceps. The stent was stabilized at the hepatic side and repositioned into the stomach, ligated, and fixed. To promote fistula formation, the gastric serosal muscle and liver parenchyma were sutured. Surgery was completed within 60min, followed by intra-abdominal lavage and drain placement ( ▶Video 1) . Obstructive jaundice resolved, and the patient was discharged on postoperative day 11 . Although biliary obstruction ▶Fig. 1 Stomach-partitioning gastrojejunostomy. a Schematic illustration showing suturing of the lesser curvature of the gastric body (yellow arrowhead) . The tumor is causing narrowing of the duodenum (*) . b An endoscopic image demonstrating the same finding, with the lesser curvature of the gastric body sutured (yellow arrowhead) . recurred 49 days later, endoscopic stent exchange via the fistula was successful. In conclusion, when a PS migrates into the abdominal cavity during EUS-HGS and its tip remains in the bile duct, surgical repositioning could correct the migrationstent and allow for biliary drainage. Surgery was completed within 60 minutes. Obstructive jaundice resolved, and the patient was discharged on postoperative day 11 . Endoscopy_UCTN_Code_CPL_ 1AL_ 2AD Contributors ʼ Statement Masafumi Watanabe: Conceptualization, Data curation, Formal analysis, Investigation, Project administration, Resources, Validation, Writing – original draft, Writing – review & editing. Kosuke Okuwaki: Validation, Writing – review & editing. Kazuharu Igarashi: Validation, Writing – review & editing. Kai Adachi: Writing – review & editing. Akihiro Tamaki: Writing – review & editing. Yusuke Kumamoto: Writing – review & editing. Chika Kusano: Writing – review & editing. Video 1 Rescue surgery was performed for intra-abdominal migration of plastic stents during endoscopic ultrasound-guided hepaticogastrostomy. Conflict of Interest The authors declare that they have no conflict of interest. E30 Watanabe Masafumi et al. Rescue surgery for… Endoscopy 2026; 58: E30–E31 | © 2026. The Author(s) . Masafumi Watanabe1 , Kosuke Okuwaki1 , Kazuharu Igarashi2, Kai Adachi1, Akihiro Tamaki1, Yusuke Kumamoto2, Chika Kusano1 1 Department of Gastroenterolog, Kitasato University School of Medicine, Sagamihara, Japan 2 Department of General-PediatricHepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan Corresponding author Masafumi Watanabe, MD, PhD Department of Gastroenterology, Kitasato Uni

FAQs

What complication was reported during endoscopic ultrasound-guided hepaticogastrostomy?

Intra-abdominal migration of a plastic stent designed for EUS-HGS, with the gastric side entering the abdominal cavity while the stent tip remained in the bile duct.

How was migration confirmed before surgery?

Computed tomography showed the stent tip remained in the bile duct, whereas the gastric side had entered the abdominal cavity, supporting intra-abdominal migration.

What was the key surgical management to correct the migration?

The emergency procedure stabilized the migrated stent at the hepatic side, repositioned it into the stomach, and fixed it while promoting fistula formation by suturing the gastric serosal muscle and liver parenchyma.

Sep 30, 2026

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