PMC6088461_01
Computed tomography scan of abdomen with contrast showing distal portion of stent traversing luminal wall into peritoneal cavity (arrow).
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An upper endoscopy was performed, confirming penetration of the stent through the lateral portion of the second part of the duodenum (Figure 1).
Endoscopic image showing perforation of duodenum with distal tip of biliary stent.
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The stent was then extracted using a Raptor  grasping device (US Endoscopy, Mentor, OH) revealing a 0.5 x 0.5 cm transmural defect (Figure 2).
Endoscopic image showing closure of defect with 4 through-the-scope clips.
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This was closed using four 11-mm TTS endoclips (DuraClip, ConMed Corporation, Utica, NY; Figure 3).