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A 87-year-old male with cancer of the prostate and cardiac decompensation was admitted with jaundice. Ultrasonography showed cholestasis, and a 2 cm stone in the common bile duct near the papilla was suspected. Endoscopic retrograde cholangiopancreatography (ERCP) showed a 1.5 cm stricture 2.5 cm above the papilla. After dilatation with a tapered 10 F dilator, a 10 F 6 cm straight biliary Teflon stent with short flaps and sideholes at the flapcuts was inserted. Endobiliary brush biopsy showed no malignant cells. The jaundice resolved, but 10 weeks later the patient was readmitted with septic cholangitis. The occluded stent was exchanged for a similar stent over a guidewire correctly located within the intrahepatic ducts. The jaundice persisted, and an attempt at inserting a second stent was not successful because the stricture was very tight. Instead, the stent was retracted 1 cm to ensure that its tip was located freely within the bile duct. A flow of clear bile was observed. After a temporary decrease the bilirubin level increased again after one week, and his general condition deteriorated. A stent exchange was therefore planned, but during extraction with a snare around the duodenal end the stent disintegrated at the level of the three proximal flaps (Figure 1) , and the proximal end, including the flaps, was stuck in the tight stenosis (Figure 2). Balloon extraction was not successful, but another plastic stent was positioned alongside and drained colourless bile. Afterwards the cardiac de-

Breakage of a Biliary Plastic Stent - A Potential Risk of Sideholes