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

## TL;DR

A rare case of colon perforation occurred due to a migrated stent used to prevent pancreatitis after an ERCP procedure.

## Contribution

This paper reports a rare complication of pancreatic stent migration causing colon perforation, emphasizing the need for improved stent design and patient monitoring.

## Key findings

- A migrated pancreatic stent caused descending colon perforation in an 87-year-old patient.
- The patient required partial colectomy and recovered without complications.
- The case underscores the importance of follow-up and safer stent design to prevent migration.

## 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.