CTICasesPerforated Esophageal Stent into an Abscess Cavity
Imaging findings
A patient with esophageal cancer had a palliative stent placed across a narrowing near the esophagogastric junction, after a difficult procedure, with an odd stent orientation and funny upper abdominal gas. Post-procedure CT shows the stent not following the esophagogastric junction but continuing laterally along the stomach wall into an abscess cavity in the upper abdomen anterior to the retroperitoneum, indicating extraluminal deployment/perforation. There is also pneumomediastinum tracking up from the abdomen and subacute lung injury with dilated airways from prior COVID.
Key takeaways
An esophageal stent can be deployed outside the lumen or perforate through undermined tumor-bearing tissue, coming to communicate with an abscess cavity, an uncommon complication beyond the more familiar stent migration. Recognizing that the stent course does not follow the expected lumen and instead tracks into a fluid collection identifies the malposition, which here required laparotomy with stent removal, drainage, and a feeding jejunostomy.
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