Laparoscopic splenic preserving distal pancreatectomy for retrieval of a proximally migrated pancreatic stent.

Ziad T Awad, MD, FACS, Justin C McCarty, BS, Michael Herman, DO, FACP, Jose Nieto, DO, FACP. University of Florida – Jacksonville.

BACKGROUND AND OBJECTIVES: Pancreatic stents placed by ERCP are common in the treatment of benign and malignant pancreatic and biliary disease. Proximal migration of the stent into the duct occurs in 2% to 5% of cases, often resulting in pancreatitis. Although technically challenging, proximally migrated pancreatic stents can usually be removed endoscopically. Little has been written about surgical management of irretrievable stents.

METHODS: A 61 year old female with a history of chronic pancreatitis underwent an ERCP with pancreatic stent placement. Soon after stent placement, it was noticed the stent had migrated into the mid-portion of the pancreas. The patient underwent four ERCP procedures attempting to remove the migrated stent with no success. Due to the patient’s ongoing abdominal pain and weight loss, the decision was made to perform a laparoscopic distal pancreatectomy with intraoperative ultrasound for removal of the pancreatic stent.

RESULTS: Using laparoscopy, we exposed the pancreas and used the ultrasound to locate the distal end of the stent. We incised the pancreas at that point, removed the stent, and completed the laparoscopic splenic preserving distal pancreatectomy. The procedure took 240 minutes, blood loss was minimal. The patient was discharged home on postoperative day 5.

CONCLUSION: Although ERCP is often successful and sometimes requires several attempts, we recommend surgical consultation after the first or second failed ERCP.

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