Laparoscopic Distal Pancreatectomy for Retrieval of a Proximally Migrated Pancreatic Stent

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, and no reports of laparoscopic approaches were found. METHODS We report on a case of unsuccessful ERCP retrieval of a proximally migrated pancreatic stent. RESULTS Using laparoscopy, we exposed the pancreas and used ultrasound to locate the distal end of the stent. We incised the pancreas at that point, removed the stent, and completed the distal pancreatectomy with splenectomy. DISCUSSION Several case series on retrieval of migrated pancreatic stents are reviewed. CONCLUSION Although ERCP is often successful and sometimes requires several attempts, we recommend surgical consultation after the first or second failed ERCP.