Recommended Citation
Costin J, Whitlock R, Donahue L, Berger E, Sankrithi P . Inadvertent Removal of Infected Hepatic Artery Stent Graft Causing Recurrent Cholangitis During Percutaneous Transhepatic Cholangiography with Internal–External Biliary Drain Placement. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Introduction/Background:
Endovascular stent-grafts are established treatments for hepatic artery stenosis and pseudoaneurysm. In rare cases there have been reports of migration/erosion, infection, and possibly serve as a persistent nidus for bacteremia. There have been reported cases of infected hepatic arterial stents and coils spontaneously excreted into the bowel and others requiring surgical intervention for removal including liver transplant. We report the first case in which percutaneous biliary access and internal– external drain placement coincided with endovascular stent migration with ultimate nonoperative removal/excretion of an infected proper hepatic artery stent-graft and resolution of recurrent cholangitis.
Description:
A patient with complex prior upper-abdominal surgery (distal gastrectomy Roux-en-Y for recurrent pediatric gastric leiomyosarcoma; tubulovillous adenoma requiring Whipple) had a 5 mm Gore Viabahn placed in the proper hepatic artery for post-Whipple arterial irregularity with subsequent stent occlusion and collateral hepatic perfusion. The patient also required chronic internal–external biliary drainage for radiation/anastomotic strictures and recurrent cholangitis. Now presenting with abdominal pain and Escherichia coli bacteremia which prompted CT showing extensive pneumobilia and intraluminal air within the hepatic artery stent. ERCP was determined to not be feasible as a result of post-surgical anatomy. Fluoroscopy demonstrated migration of the infected stent into the duodenum during percutaneous transhepatic cholangiography (PTC) and placement of a 10F internal– external biliary drain. Follow up CT showed progression of the device through the bowel and eventual radiographic absence consistent with excretion. The patient’s leukocytosis and LFT abnormalities normalized within 24 hours, and no further bacteremia was noted.
Discussion:
We present a novel case in which PTC and biliary instrumentation precipitated device migration into the GI tract, specifically in a patient with enteric communication and an infected hepatic arterial device. This case demonstrates that conservative nonoperative passage/excretion is possible with device migration into the bowel. Clinically it is important that this patient population remains physiologically stable with effective biliary drainage during this period to allow migration; multidisciplinary assessment and close follow-up were essential in management.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
wf_yes
Document Type
Poster
Open Access
Available to all.
Inadvertent Removal of Infected Hepatic Artery Stent Graft Causing Recurrent Cholangitis During Percutaneous Transhepatic Cholangiography with Internal–External Biliary Drain Placement
Introduction/Background:
Endovascular stent-grafts are established treatments for hepatic artery stenosis and pseudoaneurysm. In rare cases there have been reports of migration/erosion, infection, and possibly serve as a persistent nidus for bacteremia. There have been reported cases of infected hepatic arterial stents and coils spontaneously excreted into the bowel and others requiring surgical intervention for removal including liver transplant. We report the first case in which percutaneous biliary access and internal– external drain placement coincided with endovascular stent migration with ultimate nonoperative removal/excretion of an infected proper hepatic artery stent-graft and resolution of recurrent cholangitis.
Description:
A patient with complex prior upper-abdominal surgery (distal gastrectomy Roux-en-Y for recurrent pediatric gastric leiomyosarcoma; tubulovillous adenoma requiring Whipple) had a 5 mm Gore Viabahn placed in the proper hepatic artery for post-Whipple arterial irregularity with subsequent stent occlusion and collateral hepatic perfusion. The patient also required chronic internal–external biliary drainage for radiation/anastomotic strictures and recurrent cholangitis. Now presenting with abdominal pain and Escherichia coli bacteremia which prompted CT showing extensive pneumobilia and intraluminal air within the hepatic artery stent. ERCP was determined to not be feasible as a result of post-surgical anatomy. Fluoroscopy demonstrated migration of the infected stent into the duodenum during percutaneous transhepatic cholangiography (PTC) and placement of a 10F internal– external biliary drain. Follow up CT showed progression of the device through the bowel and eventual radiographic absence consistent with excretion. The patient’s leukocytosis and LFT abnormalities normalized within 24 hours, and no further bacteremia was noted.
Discussion:
We present a novel case in which PTC and biliary instrumentation precipitated device migration into the GI tract, specifically in a patient with enteric communication and an infected hepatic arterial device. This case demonstrates that conservative nonoperative passage/excretion is possible with device migration into the bowel. Clinically it is important that this patient population remains physiologically stable with effective biliary drainage during this period to allow migration; multidisciplinary assessment and close follow-up were essential in management.
Affiliations
Aurora St. Luke's Medical Center