The authors present a case report of a patient with distal plastic biliary stent migration resulting in perforation through a sigmoid diverticulum. The perforation was contained by a loop of ileum that had descended into the pelvis allowing for a sigmoid resection with primary anastomosis. This rare complication of biliary stent placement should be included in differential diagnosis of any patient that presents with lower quadrant abdominal pain after endoscopic retrograde cholangiopancreatography with stent placement.
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