-Case Reports-

Fracture of an Expandable Metallic Stent Placed for Biliary Obstruction due to Common Bile Duct Carcinoma

Hiroshi Yoshida¹, Yasuhiro Mamada¹, Nobuhiko Taniai¹, Yoshiaki Mizuguchi¹, Tetsuya Shimizu¹, Takayuki Aimoto¹, Yoshiharu Nakamura¹, Tsutomu Nomura¹, Shigeki Yokomuro¹, Yasuo Arima¹, Eiji Uchida¹, Hirofumi Misawa², Eiichi Uchida² and Takashi Tajiri¹

¹Surgery for Organ Function and Biological Regulation, Nippon Medical School Graduate School of Medicine
²Uchida Hospital, Tokyo

We report our second case of fracture of a SMART self-expandable metallic stent (Cordis Endovascular, Warren, NJ) placed to treat biliary obstruction due to an unresectable common bile duct carcinoma. An 82-year-old man presented with jaundice. Computed tomography and ultrasonography on admission demonstrated a mass in the lower common bile duct. The mass was identified as a common bile duct obstruction. A SMART stent was inserted. Ten months after stent insertion, two additional SMART stents were inserted to relieve obstructive jaundice due to occlusion of the first stent. Fourteen months after insertion of the first stent, endoscopic examination revealed stenosis of the duodenum due to invasion of the common bile duct carcinoma, prompting us to perform a gastrojejunostomy 1 month later. Three months after gastrojejunostomy, the patient presented with obstructive jaundice and cholangitis. A fracture of one of the stents was then discovered on plain X-ray films and percutaneous transhepatic cholangiography. Two SMART stents were inserted simultaneously. In conclusion, we report the fracture of a SMART stent placed for common bile duct carcinoma. Fracture should be considered as a possible complication after metallic stent insertion.

J Nippon Med Sch 2006; 73: 164-168

Keywords
expandable metallic stent, common bile duct carcinoma, obstructive jaundice, fracture

Correspondence to
Hiroshi Yoshida, MD, Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
hiroshiy@nms.ac.jp

Received, February 14, 2006
Accepted, March 28, 2006