[15] Such bilomas were likely sterile, or at least not as heavily contaminated as an abscess. Given the patient’s past medical history, including advanced age, prior abdominal surgery, and cardiac status, we surmised that percutaneous drainage of the abscess posed a lower risk than a laparotomy. We concluded that drainage of the abscess would alleviate her small bowel obstruction, allow her inflammatory changes to resolve, and provide the time necessary for her to become nutritionally replete. In essence, we chose to treat this patient in a fashion similar to a complicated diverticular

abscess or a perforated appendicitis with abscess formation. Prior reports involving biliary stent migration have advocated aggressive

surgical intervention PF-01367338 clinical trial for patients with large infected intra-abdominal collections, delayed or critically ill clinical presentations, or a low physiologic reserve.[4, 5] We had considered operative removal of the biliary stent after the check details patient had recovered clinically. However, the stent was able to be removed percutaneously during a drain upsizing. The patient had a 15 day hospital course and an extended period of percutaneous drainage. Of note, she initially refused operative intervention via laparoscopy or laparotomy to resect the enteroperitoneal fistula and selleck screening library preferred this treatment path. Conclusion As percutaneous interventional techniques improve, cases that now require emergent surgical intervention may soon be better served by these less invasive techniques. In this circumstance,

fluoroscopically guided percutaneous removal of a migrated biliary stent distal to the LOT, coupled with traditional conservative management principles in the treatment of enterocutaneous fistulas obviated the need for aggressive surgical intervention. This approach has not been previously documented. We conclude that fluoroscopic retrieval of migrated biliary stents associated with perforation distal to the LOT, along with percutaneous abscess Protein Tyrosine Kinase inhibitor drainage, may be a safe and effective treatment alternative to laparotomy for stable patients, even when associated with a large intra-abdominal abscess. Consent This activity was screened by our Institutional Review Board for exempt status according to the policies of this institution and the provisions of applicable regulations and was found not to require formal IRB review because it did not meet the regulatory definition of research. References 1. Lammer J, Neumayer K: Biliary drainage endoprostheses: experience with 201 placements. Radiology 1986,159(3):625–629.PubMed 2. Mueller PR, Ferrucci JT Jr, Teplick SK, vanSonnenberg E, Haskin PH, Butch RJ, Papanicolaou N: Biliary stent endoprosthesis: analysis of complications in 113 patients. Radiology 1985,156(3):637–639.PubMed 3. Johanson JF, Schmalz MJ, Geenen JE: Incidence and risk factors for biliary and pancreatic stent migration. Gastrointest Endosc 1992,38(3):341–346.CrossRefPubMed 4.