Rare Case

1. Migration of
CBD Stent
Dr. Ramendranath Talukdar (Professor, Department of General Surgery)
Dr. Amandeep Singh (PG 3rd year, Department of General Surgery)

2. Have you heard people talk about
“minimally invasive” surgery?

3. Laparoscopic surgery is one
kind.
Doctors first used it for
Gallbladder Surgery and
gynecology operations.

5. CASE HISTORY

6. 62 year male
• Pain in right hypochondrium since 2 months.
• Dyspepsia and
• Vomit on having fatty/oily food.
• No significant past history.

7. Clinical examination
•Vitally normal
•Tenderness over right hypochondrium
region.

8. Investigations
• Bilirubin: 0.8
• SGOT: 138
• SGPT: 212
• ALP: 577
• INR: 1.1
• TSH: 2.82

9. Ultrasound abdomen
• Distended gall bladder with multiple focal signal
void area suggestive of multiple calculi approx
7mm largest measuring with dilated CBD 11.5mm
in diameter.

10. MRCP
•Dilated CBD of
11.5mm in diameter
just proximal to site of
insertion into D2 with
CBD stone.

11. • Patient had undergone ERCP with stenting on
15 June 2022
• Followed by laparoscopic cholecystectomy
done on 27 July 2022

12. OPERATIVE PROCEDURE

13. On laparoscopic cholecystectomy
tube like structure

16. throughout from
fundus to cystic
duct

19. Cutting of gall
bladder at
fundus

20. Identification
of stent

21. Pulling of stent
out of gall
bladder

27. Removal of
stent

30. Post-operative Gall Bladder
Specimen with the Stent

31. This case report is aimed at
comparing the migration of CBD
stent in gall bladder encountered
during LC following ERCP.

32. Migration/Misplacement of CBD Stents
• About 8.4%
• Proximal migration: 3.0%
• Distal migration: 5.4%
European Journal Gastro-enterology and Hepatology (July 2021)

33. In conclusion, the optimum time to
perform LC is within 3 days after
ERCP.

34. Different types of CBD stents

35. The longer the interval between ERCP
and LC, the higher are the chances of
encountering complications and
increased need for conversion as well as
prolonged operating time and hospital
stay.

36. Though LC following ERCP is the gold
standard for choledocholithiasis (seen
in 10% patients of Gall Bladder stone)
in the current general surgical practice,
the operating surgeon should always be
aware of our case difficulty
encountered.

37. Knowledge of these challenges will
enable the surgeon in providing a safer
and more favorable outcome in
cholecystectomy.

38. Thankyou……...............