Dr. Raman Garg Successfully Treats a Rare Case of Giant Stone Formation Around a Forgotten Biliary Stent
Plastic biliary (CBD) stents are temporary devices commonly placed during ERCP (Endoscopic Retrograde Cholangiopancreatography) to relieve biliary obstruction. These stents are intended to be removed or exchanged within the recommended follow-up period. Failure to do so can result in serious complications, including recurrent jaundice, cholangitis, pancreatitis, and large bile duct stone formation.
Dr. Raman Garg, Senior Surgical Gastroenterologist, Hepatobiliary (HPB) Surgeon, GI Cancer Surgeon, and Advanced Laparoscopic Surgeon, successfully managed this rare and preventable biliary complication by performing definitive common bile duct exploration and complete clearance of the obstructed bile duct.
Patient Presentation
A 50-year-old female presented with:
- Recurrent upper abdominal pain.
- Progressive jaundice.
- Symptoms suggestive of biliary obstruction.
Five years earlier, she had undergone ERCP with placement of a plastic CBD stent, and Open Cholecystectomy for gallstone disease.
Ultrasonography suggested choledocholithiasis (common bile duct stones), and definitive surgery was planned.
A Rare Intraoperative Finding
During surgery, Dr. Raman Garg identified an unusual and completely preventable cause of biliary obstruction.
The plastic CBD stent inserted during ERCP five years earlier was still present inside the common bile duct. The patient had missed the scheduled follow-up for stent removal.
Over the years, the retained plastic stent acted as a nidus for stone formation, resulting in a giant common bile duct stone completely encasing the forgotten stent, producing biliary obstruction and recurrent jaundice.
Definitive Hepatobiliary Surgery by Dr. Raman Garg
The patient underwent:
- Common Bile Duct (CBD) Exploration.
- Removal of the forgotten plastic CBD stent.
- Extraction of the giant stent-related bile duct stone.
- Complete clearance of the biliary tree.
The procedure successfully restored normal bile flow and eliminated the source of obstruction.
The surgery was successfully performed by Dr. Raman Garg at Bombay Gastro & Cancer Institute, Bathinda.
Excellent Postoperative Recovery
The patient recovered uneventfully:
- Complete relief of jaundice.
- Resolution of abdominal pain.
- Early resumption of oral diet.
- No postoperative complications.
- Discharged in satisfactory condition.
Why This Case Is Important
Forgotten biliary stents are an entirely preventable cause of serious biliary complications.
Plastic biliary stents are generally intended to remain in place only for a limited period and should be removed or exchanged according to the treating specialist's advice. If neglected, they may lead to giant bile duct stone formation, recurrent jaundice, cholangitis (bile duct infection), biliary obstruction, acute pancreatitis, and difficult future endoscopic or surgical removal.
This case demonstrates:
- A rare giant stone completely encasing a forgotten CBD stent.
- Successful definitive hepatobiliary surgery after years of retained stent.
- The importance of long-term follow-up after ERCP.
- How patient education can prevent avoidable biliary emergencies.
This case also highlights the importance of maintaining proper medical records and adhering to follow-up instructions after ERCP and biliary stenting.
Patient Education
If a plastic biliary stent is placed during ERCP, it is essential to return for follow-up as advised by your treating gastroenterologist or hepatobiliary surgeon. A forgotten stent can become the center of stone formation and may eventually require major surgery. Always keep a record of your ERCP procedure and ensure that temporary biliary stents are removed or replaced within the recommended timeframe.
Advanced Hepatobiliary Surgery by Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist, Hepatobiliary (HPB) Surgeon, GI Cancer Surgeon, Advanced Laparoscopic Surgeon, and Colorectal Surgeon based in Bathinda, Punjab. He has extensive expertise in common bile duct (CBD) exploration, difficult bile duct stone surgery, failed ERCP cases, and hepatobiliary surgery, focusing on evidence-based, patient-centered care.
Patients from Bathinda, Punjab, Haryana, Rajasthan, and neighbouring states seek treatment from Dr. Raman Garg for advanced hepatobiliary and bile duct surgical care.
Patient: 50-year-old Female
Diagnosis: Forgotten Common Bile Duct (CBD) Stent; Giant Stent-Related Choledocholithiasis; Obstructive Jaundice
Previous Procedures: ERCP with Plastic CBD Stenting, Open Cholecystectomy (5 years earlier)
Definitive Procedure Performed: Common Bile Duct Exploration, Removal of Forgotten CBD Stent, Extraction of Giant CBD Stone, Complete Biliary Clearance
Operating Surgeon: Dr. Raman Garg, Surgical Gastroenterologist, Hepatobiliary (HPB) Surgeon, Bombay Gastro & Cancer Institute, Bathinda
Outcome: Successful removal of the forgotten stent and giant stone with complete relief of biliary obstruction and an uneventful recovery.
About Dr. Raman Garg
Dr. Raman Garg is a Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic and HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda. He specializes in gastrointestinal cancer surgery, liver, pancreas and bile duct surgery, colorectal surgery, hernia surgery, upper GI surgery, emergency abdominal surgery, and advanced minimally invasive procedures.
Patient identity has been withheld to maintain confidentiality. This case is published solely for educational purposes and with due respect for patient privacy.
