Acute Cholangitis Secondary to a Clogged Biliary Stent: A Review on the Cause of Clogging and the Appropriate Time of Replacement

Choledocholithiasis is preferably treated by endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and stone removal, to reduce the risk for acute cholangitis. Frequently, patients who are ill, surgically unfit, or unable to undergo stone extraction during the index procedure underwent antibacterial treatment and temporary biliary stenting via ERCP to prevent biliary sepsis and septic shock. After a period of convalescence, a repeat ERCP is scheduled to clear the bile duct and remove the stent, followed by laparoscopic cholecystectomy to complete the treatment circuit. Cholangitis may often recur in patients with an indwelling biliary stent while waiting for definitive treatment. Here, we present a case of a 42-year-old female with choledocholithiasis who developed moderate acute cholangitis 5 months after ERCP and insertion of a biliary plastic stent. She was provisionally diagnosed with obstructive jaundice with concurrent acute cholecystitis. Through intravenous antibacterial therapy, stent exchange, and an interval open cholecystectomy, she had fully recovered. We also discuss the underlying mechanism of stent blockage and the optimal interval for stent exchange after temporary placement for benign cases. Understanding the pathophysiology of stent clogging and recognizing the optimal interval for stent replacement may help reduce the risk of stent clogging and potentially fatal acute cholangitis.