Oesophageal stent migration following Billroth I gastrectomy: an unusual cause of small bowel obstruction
An 81-year-old female with a 24 h history of acute, worsening abdominal pain with associated abdominal distension and bilious vomiting was referred by her GP to the general surgical admissions unit. The patient reported no other gastrointestinal symptoms and there was no prelude to the presentation.\nThe patient had an extensive surgical history. She had undergone a Billroth I gastrectomy in 1977 for peptic ulcer disease, a splenectomy following blunt trauma in 1989 and further gastric surgery for a cancer in 1999. During a therapeutic endoscopy for a benign stricture 4 months previously, the patient had suffered an iatrogenic perforation. This was treated endoscopically with the deployment of a Hanaro-antireflux covered stent, covering the defect that was identified at 35 cm. The stent was deployed at 32–41 cm. These margins were chosen in order to give a ±3 cm cover of the perforation. The extra 2 cm distal cover was because the stent was the only suitable stent available that would be both wide enough to remain in situ and long enough to give adequate cover of the perforation. There were no concerns regarding the apposition of the stent, and the stent was not sutured in place. Routine follow-up was arranged for 4–6 weeks; however, for an unconfirmed reason, this follow-up never took place.\nOn presentation, her physiological observations were stable and she was apyrexial. The abdomen was very distended, tympanic and tender on palpation. Bowel sounds were not present.\nBlood results on admission, including liver function, urea and electrolytes, CRP, amylase, lactate and full blood count, were within normal limits.\nAbdominal X ray showed multiple distended loops of small bowel with a migrated stent inside small bowel Fig. .\nFollowing the diagnosis of mechanical small bowel obstruction due to oesphageal stent migration, the patient was booked and consented for a laparotomy. At laparotomy, distended small bowel was found, with the cause of the obstruction being found in the distal ileum. The bowel was viable, and there was no associated perforation. A small enterotomy was made and the stent was extracted. The enterotomy was closed primarily, and the abdomen was washed out and closed.\nPost-operative recovery was unremarkable, and the patient was discharged home with regular follow-up in 6–8 weeks.