Vertical rotation and impaction to the choledochal duct of a migrated biliary self-expanding metal stent.

: Self-expanding metal stent (SEMS) placement is a well accepted and highly effective method for both treating and palliating obstructive lesions of the biliary tree, still complications may occur including premature occlusion and stent migration. Migration can occur either proximally or distally, usually early after SEMS placement and almost exclusively in covered ones. Distal migration is the most common type and is reported in 5.8% to 6% of cases. In our case, proximal migration of the stent occurred and surprisingly it rotated and impacted to the common bile duct transversally. This precluded any attempt to reposition or remove the SEMS. We effectively treated this unusual complication by placing an additional plastic stent into the common bile duct that restored biliary drainage.