EURORAD ESR

Case 12541

Iatrogenic duodenal perforation from palliative positioning of self-expandable metal stent

Author(s)
Tonolini Massimo, MD

"Luigi Sacco" University Hospital,
Radiology Department;
Via G.B. Grassi 74
20157 Milan, Italy;
Email:mtonolini@sirm.org
 
Patient
male, 79 year(s)
 
 
  • Figure 1
    Pre-procedural contrast-enhanced multidetector CT + percutaneous biliary stenting
     

    Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: CT; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Following removal of plastic biliary stent, percutaneous cholangiographic images showed opacification of dilated intrahepatic and common bile ducts from tight choledochal stricture (f), treated with positioning of...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Obstruction / Occlusion;

    Following removal of plastic biliary stent, percutaneous cholangiographic images showed opacification of dilated intrahepatic and common bile ducts from tight choledochal stricture (f), treated with positioning of...

     
    Area of Interest: Biliary Tract / Gallbladder; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 2
    Urgent post-procedural contrast-enhanced multidetector CT
     

    Image review at lung window settings showed bilateral retroperitoneal air (*) from duodenal perforation. Note metallic biliary stent in place (arrowhead).

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Staging; Special Focus: Fistula;

    Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the...

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Staging; Special Focus: Fistula;

    Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the...

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Staging; Special Focus: Fistula;

    Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the...

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Staging; Special Focus: Fistula;

    Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the...

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: CT; Procedure: Staging; Special Focus: Fistula;
     
     
  • Figure 3
    Endoscopic injection of contrast medium under fluoroscopy
     

    Despite superimposition of the biliary stent, repeated endoscopy verified patency of the duodenal stent (a) with its distal end (arrowhead in b) protruding outside the duodenal lumen for over 1 cm.

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Fistula;

    Repeated endoscopy verified patency of the duodenal stent (a) with its distal end (arrowhead in b) protruding outside the duodenal lumen for over 1 cm. Contrast medium injection through the duodenal stent opacified...

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Fistula;
     
     
  • Figure 4
    Upper gastrointestinal study with water-soluble contrast medium
     

    After repeated surgery with duodeno-jejunostomy, upper gastrointestinal fluoroscopic study with water-soluble contrast medium showed persistent leakage (arrows) in the retroperitoneum.

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: Fluoroscopy; Procedure: Surgery; Special Focus: Fistula;

    After repeated surgery with duodeno-jejunostomy, upper gastrointestinal fluoroscopic study with water-soluble contrast medium showed persistent leakage (arrows) in the retroperitoneum.

     
    Area of Interest: Gastrointestinal tract; Imaging Technique: Fluoroscopy; Procedure: Stents; Special Focus: Fistula;
     
     
Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction (+) despite plastic stent in site.
 
Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction (+) despite plastic stent in site.
 
Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction (+) despite plastic stent in site.
 
Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction (+) despite plastic stent in site.
 
Axial (a..c in caudocranial order) and coronal (d,e) images showed solid tissue (arrowheads) corresponding to known carcinoma of the Vaterian ampulla, causing moderate duodenal dilatation (*) and biliary obstruction (+) despite plastic stent in site.
 
Following removal of plastic biliary stent, percutaneous cholangiographic images showed opacification of dilated intrahepatic and common bile ducts from tight choledochal stricture (f), treated with positioning of metallic biliary prosthesis (g).
 
Following removal of plastic biliary stent, percutaneous cholangiographic images showed opacification of dilated intrahepatic and common bile ducts from tight choledochal stricture (f), treated with positioning of metallic biliary prosthesis (g).
 
Image review at lung window settings showed bilateral retroperitoneal air (*) from duodenal perforation. Note metallic biliary stent in place (arrowhead).
 
Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the lumed at the third duodenum.
 
Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the lumed at the third duodenum.
 
Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the lumed at the third duodenum.
 
Axial (b...d in craniocaudal order) and coronal reformatted (e) images showed retroperitoneal air (*), biliary stent (arrowheads), duodenal SEMS (arrows) with its distal portion (thin arrows) protruding outside the lumed at the third duodenum.
 
Despite superimposition of the biliary stent, repeated endoscopy verified patency of the duodenal stent (a) with its distal end (arrowhead in b) protruding outside the duodenal lumen for over 1 cm.
 
Repeated endoscopy verified patency of the duodenal stent (a) with its distal end (arrowhead in b) protruding outside the duodenal lumen for over 1 cm. Contrast medium injection through the duodenal stent opacified extraluminal leaks (arrows).
 
After repeated surgery with duodeno-jejunostomy, upper gastrointestinal fluoroscopic study with water-soluble contrast medium showed persistent leakage (arrows) in the retroperitoneum.
 
After repeated surgery with duodeno-jejunostomy, upper gastrointestinal fluoroscopic study with water-soluble contrast medium showed persistent leakage (arrows) in the retroperitoneum.
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version