PMC5814569_01
Computed tomography showing large, walled-off necrotic collection in the pancreatic tail region.
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F1
Computed tomography (CT) showed a complex, heterogeneous 9-cm walled-off fluid collection adjacent to the pancreatic tail (Figure 1).
Endoscopic view after deployment of a lumen-apposing metal stent.
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F2
She underwent EUS-guided transgastric drainage of the walled-off necrosis using a 15-mm cautery-enhanced LAMS with a flange diameter of 24 mm (AXIOS, Boston Scientific, Marlborough, Massachusetts) (Figure 2).
Computed tomography 1 week after deployment of lumen-apposing metal stent showing resolution of walled-off necrosis. Lumen-apposing metal stent is appropriately positioned in the gastric wall.
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F3
Follow-up CT a week after LAMS deployment showed nearly complete resolution of walled-off necrosis, and the LAMS was appropriately positioned in the gastric wall (Figure 3).
Computed tomography a few weeks after deployment, suggesting migration of the lumen-apposing metal stent, which is visible in gastric lumen.
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F4
Repeat CT scan a few weeks later did not show re-accumulation of peri-pancreatic fluid; however, the stent had migrated out of the cyst-gastrostomy and into the gastric lumen (Figure 4).
Fluoroscopy image showing the lumen-apposing metal stent in the pelvic cavity.
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F5
AXIOS stent was noted to have migrated out of the gastric cavity and was visible in the pelvis on fluoroscopy (Figure 5). A flexible sigmoidoscopy was performed, and the AXIOS stent was retrieved from the rectum with a rat-tooth forceps.