ERCP 後膵炎予防目的に留置した自然脱落型膵管ステントによる小腸穿孔の 1 例

Post-ERCP pancreatitis is the most common and potentially most serious complication after ERCP. A great deal of medical literature describes the efficacy and safety of the prophylactic pancreatic spontaneous dislodgement stent placement in reducing the incidence of post-ERCP pancreatitis, and the 2015 guidelines for the management of post-ERCP pancreatitis recommend its use for high-risk patients. Serious complications such as intestinal perforation due to migration of this pancreatic spontaneous dislodgement stent have been rarely reported. Herein, we report a case with small intestine perforation induced by a migrated pancreatic spontaneous dislodgement stent. An 82-year-old woman with a surgical history of laparoscopic right hemicolectomy for colon cancers, and open operation for small intestinal ileus due to peritoneal metastasis underwent ERCP for obstructive jaundice. Selective bile duct cannulation was unsuccessful, and the pancreatic spontaneous dislodgement stent (5Fr diameter, 5 cm, straight type) was placed to prevent post-ERCP pancreatitis. Twenty-one days after ERCP, the patient complained of abdominal pain and was hospitalized. Computed tomography revealed small intestinal perforation because of pancreatic spontaneous dislodgement stent migration, and surgical treatment was performed. The indications should be carefully considered when a prophylactic pancreatic spontaneous dislodgement stent is placed to prevent post-ERCP pancreatitis. Moreover, we should pay attention to severe complications, including intestinal perforation, and careful observation after placement of a prophylactic pancreatic spontaneous dislodgement stent is needed.