Clin Endosc.  2019 May;52(3):288-292. 10.5946/ce.2018.128.

Pneumoperitoneum after Endoscopic Duodenal Stent Insertion in a Patient with Percutaneous Transhepatic Biliary Drainage and Biliary Stent: A Case Report

  • 1Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 2Department of Radiology, Chungbuk National University Hospital, Cheongju, Korea.
  • 3Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea.


Early removal of a percutaneous transhepatic biliary drainage (PTBD) tube commonly causes pneumoperitoneum. However, we encountered a patient who developed pneumoperitoneum even with an indwelling PTBD tube. An 84-year-old man was admitted with type III combined duodenal and biliary obstruction secondary to metastatic bladder cancer. A biliary stent was placed using a percutaneous approach, and a duodenal stent was placed endoscopically. A large amount of subphrenic free air was detected after the procedures. Laboratory tests indicated intestinal perforation; however, peritoneal signs were absent. The patient was treated conservatively using an indwelling Levin tube. Seven days later, the massive amount of subphrenic free air disappeared. Follow-up tubography revealed unrestricted bile flow into the small intestine, and the PTBD tube was removed. Prolonged endoscopic procedures in patients with a PTBD tract communicating with the gastrointestinal tract can precipitate pneumoperitoneum. Clinicians should be careful to avoid misdiagnosing this condition as intestinal perforation.


Pneumoperitoneum; Combined duodenal and biliary obstruction; Percutaneous transhepatic biliary drainage; Biliary stenting; Duodenal stenting

MeSH Terms

Aged, 80 and over
Follow-Up Studies
Gastrointestinal Tract
Intestinal Perforation
Intestine, Small
Urinary Bladder Neoplasms
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