First report of an appendiceal perforation caused by a migrated biliary stent after orthotopic liver transplantation

The overall incidence of biliary strictures in liver transplantedpatients is around 13% [1], mostly located at the biliary anasto-mosis, occurring from 6 to 12% of cases [2]. The first treatmentoption of anastomotic biliary strictures is the insertion of aplastic or metallic biliary prosthesis with endoscopic retrogradecholangiopancreatography (ERCP). Distal migration of biliarystent is an unusual complication related to this procedure, oc-curring in about 6% of patients [3], but in literature cases ofabdominal visceral perforation due to this complication aredescribed, mainly involving small intestine and colon [4-6]. Anisolated case of appendiceal perforation related to stent dislo-cation is found in literature [6].