Conservative Treatment of Sigmoid Diverticulum Perforation Secondary to Migrated Biliary Plastic Prostheses Inserted by Endoscopic Retrograde Cholangiopancreatography: A Case Report of an Unusual Adverse Event and Literature Review.

Distal migration of biliary plastic stents is rare. Although these stents are primarily used in the treatment of benign diseases of the biliopancreatic tract, their distal migration can lead to severe complications, such as perforation of any part of the digestive system. The authors report a case of sigmoid diverticulum perforation caused by the migration of a biliary plastic stent, which had been initially placed due to a failure to extract a common bile duct (CBD) stone. A review of similar cases in the literature was conducted, and the findings were analyzed in relation to the reported case. The search was performed in MEDLINE and the Cochrane Library, covering studies published between 1975 and 2025. Only studies describing the placement of biliary plastic stents during endoscopic retrograde cholangiopancreatography (ERCP) were included, while studies with incomplete data were excluded. This study highlights this rare and serious complication, which carries a high morbidity rate. Despite careful stent positioning during ERCP and periodic follow-up, this adverse event (AE) cannot always be prevented. Although distal stent migration with perforation can often be treated endoscopically, preoperative evaluation of the patient's clinical condition and precise localization of the perforation is crucial for successful endoscopic stent removal, thus avoiding the need for surgery.