ARRS 2022 Abstracts

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E1665. Complications of Common Bile Duct Stents on CT
Authors
  1. Neel Shroff; The University of Texas Medical Branch
  2. Hasan Khan; The University of Texas Medical Branch
  3. Woongsoon Choi; The University of Texas Medical Branch
  4. Maryamnaz Falamaki; The University of Texas Medical Branch
  5. Peeyush Bhargava; The University of Texas Medical Branch
Background
The use of common bile duct stents has increased in prevalence as an option for management of obstructive jaundice caused by malignancy, benign biliary strictures, or choledocholithiasis. Procedures to put in stents are minimally invasive and associated with low rates of morbidity; however, short-term complications such as pancreatitis, hemorrhage, perforation, and cholangitis have been noted to occur in 5–10% of patients. Biliary stenting is usually a short-term bridge to surgery, butsome high-risk patients may need to have stents implanted for longer periods of time. Long-term complications of common bile duct stents include stent occlusion and stent migration. These short- and long-term complications are associated with high morbidity, and early detection using CT can improve prognostic outcomes.

Educational Goals / Teaching Points
The objective of this educational exhibit is to describe common short- and long-term complications of common bile duct stents as seen on CT.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Common bile duct stents are used to relieve biliary obstruction caused by benign or malignant processes. Although it is uncommon, stents themselves can lead to biliary obstruction. Accumulation of biliary sludge may result in stent occlusion. In some cases, the stent may serve as a nidus for biliary stone formation. This can be further complicated by ascending bacterial infection, resulting in cholangitis. Migration of the stent can also cause complications depending on anatomical location. For example, obstruction of the pancreatic duct by the stent can lead to pancreatitis. In most cases, migrated stents pass through the bowel without complication. However, the duodenum is a common site in which complications can occur, and several case reports have documented duodenal perforation secondary to stent migration. These varying complications can be effectively identified on CT. CT imaging can demonstrate migration and precise anatomical location of the stent. It can also display obstruction and subsequent dilation of obstructed areas. Inflammatory and edematous changes can be seen on CT due to the presence of local fat stranding. Perforation can be identified as non-dependent free air. Clinical suspicion of complications involving biliary stents should be quickly evaluated using CT to determine subsequent management.

Conclusion
Common bile duct stents are useful in the management of biliary obstruction. However, complications involving common bile duct stents such as pancreatitis, cholangitis, occlusion, and perforation are associated with high morbidity. CT is an essential tool for prompt diagnosis of these complications.