Spontaneous tearing of a duodenal metallic stent: a rare adverse event

Duodenal metallic stent placement is one of the options for the palliative treatment of malignant duodenal obstruction [1]. However, this palliative procedure is associated with several adverse events; stent migration, bleeding, and perforation have been reported [2–5]. If the site of obstruction is in the duodenal bulb, the duodenal stent should be placed from the stomach to the duodenum across the pylorus. At this site, stent injury may be caused by pyloric spasm. Herein, we describe a rare adverse event – duodenal metallic stent tearing due to pyloric spasm – and our successful re-intervention. A 67-year-old man was admitted to our hospital because of nausea and vomiting. He had undergone chemotherapy for bladder cancer. In addition, an uncovered duodenal metallic stent (Niti-S, 22mm× 12cm; TaeWoong Medical, Seoul, Korea) had been placed from the stomach to the second part of the duodenum because of duodenal bulb stenosis resulting from malignant peritonitis 2 months earlier. Computed tomographic and fluoroscopic imaging showed tearing of the duodenal stent (●" Figs.1,2). Therefore, we tried to re-intervene. A gastroduodenoscope was inserted into the stomach, and tearing of the duodenal metallic stent was again seen (●" Fig.3). First, we trimmed the metallic stent with a diathermic dilator (●" Fig.4) and removed it (●" Fig.5,●" Video 1). Then, we placed a fully covered duodenal metallic Fig.1 Computed tomography shows a torn duodenal metallic stent, placed in a 67-year-old man to manage duodenal bulb stenosis resulting from previous malignant peritonitis.