Early Duodenal Perforation Due to Migrated Plastic Biliary Stent, Successfully Managed Endoscopically: A Case Report.

Endoscopic retrograde cholangiopancreatography (ERCP) with plastic biliary stent placement is a common treatment for biliary obstruction. Although stent migration occurs in up to 10% of cases, duodenal perforation is rare and associated with significant morbidity if diagnosis is delayed. We report the case of a man in his 60s who underwent ERCP with insertion of a 70-mm duodenal-bend plastic biliary stent for acute cholangitis. Ten days later, he re-presented with acute abdominal pain and elevated inflammatory markers. Imaging and repeat ERCP demonstrated distal stent migration with duodenal perforation. The stent was removed, and the defect was successfully managed with a single through-the-scope clip. Notably, this complication occurred despite the absence of recognised risk factors for stent migration or perforation, suggesting that clinically significant stent-related complications may occur even in patients considered to be at relatively low risk. This case emphasises the need to consider stent-related complications in any patient presenting with abdominal pain after ERCP and demonstrates that early endoscopic management can achieve favourable outcomes in appropriately selected patients.