PMC8411612_01
ERCP in tight filling phase. The wire conductor was inserted into the
posterior sectional bile duct through the right hepatic duct: (A) the
dilatation of the intrahepatic bile ducts up to 11 mm was determined and (B)
the endobiliary PVC stent 10 Fr 150 mm was installed into the right
posterior sectional bile duct followed by free passage of contrast medium
into the duodenum.
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The polyvinyl chloride (PVC) stent (10 Fr, 150 mm) was placed into the right hepatic duct (Figure 1) and colorless "white" bile was received.
Illustration of restenting stages by ERCP of the previously installed and
completely occluded endobiliary 10 Fr stent: (A) ERCP in the tight filling
phase showed absence of the contrast passage to the common bile duct
indicating occlusion of the stent. (B) The wire conductor was introduced to
the right hepatic and the posterior sectional bile ducts. The dilated common
hepatic duct and proximal bile ducts were filled with contrast medium. (C)
The PVC endobiliary stent 11.5 Fr 130 mm was placed to the right posterior
sectional bile duct. (D) Illustration of free passage of contrast medium
into the duodenum.
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Occlusion of the PVC stent was established by MRI, followed by ERCP (Figure 2), and replacement of the stent was performed with a larger diameter (11.5 Fr, 130 mm).
Chest and abdomen CT scan: A and C:Routine 1.5 B31s; B and D:Routine 1.5
B70s; E:Topogram 0.6 T20f. (A and B) The proximal end of the stent is
located in the posterior part of the lower lobe of the right lung (indicated
by an arrow), surrounded by an infiltration area. (C and D) The distal end
of the endobiliary stent (indicated by an arrow) is displaced into the
common hepatic duct.
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CT scan showed the proximal migration of the endobiliary stent with penetration through the liver, the right dome of the diaphragm, and right lung (Figure 3). The distal part of the stent was at the level of the common hepatic duct (Figure 3C and D).
Chest and abdomen MRI follow-up showing the presence of biliary-bronchial
fistula (BBF). Arrows indicate the bronchial portion of BBF with signs of
perifocal pneumonsclerosis in both images. (A-C) MRI signs of BBF at
4 months after the diagnosis. (D-F) MRI signs of BBF at 9 months after the
diagnosis.
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MRI investigation showed signs of fibrotic tissue around the part of the endobiliary stent in the pulmonary parenchyma with a clear demarcation from the normal lung tissue (Figure 4).
Illustration of ERCP findings: (A) The X-ray image before retrieval of the
migrated endobiliary stent 11.5 Fr 130 mm (indicated by an arrow). The
proximal part of the stent was migrated to the common hepatic duct, whereas
the distal end was migrated to the lower lobe of the right lung. (B) The
X-ray image after removal of the migrated stent and re-draining right
hepatic duct with a new stent 10 Fr 150 mm (indicated by an arrow).
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The removed stent was replaced with a PVC stent (10 Fr, 150 mm) by ERCP (Figure 5).