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1Department of Medicine, McMaster University, Hamilton; 2Department of Gastroenterology, Sunnybrook Health Science, Toronto, Ontario Correspondence: Dr Lawrence Cohen, Department of Gastroenterology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, HG-63, Toronto, Ontario M4N 3N5. Telephone 416-480-4725, fax 416-480-5977, e-mail lawrence.cohen@sunnybrook.ca Received for publication June 21, 2014. Accepted July 1, 2014 CASE PRESENTATION A 67-year-old woman was brought to the endoscopy unit in May 2014 for removal of a covered self-expanding metal stent (SEMS) from the common bile duct (CBD), initially placed in May 2013 to manage recurrent cholangitis. The patient developed idiopathic pancreaticobiliary dysmotility following cholecystectomy in 2001. She experienced recurrent episodes of pancreatitis and cholangitis for which she required numerous endoscopic retrograde cholangiopancreatograms, including the insertion of biliary plastic stents to facilitate drainage, extraction of CBD stones and/or clearing debris from the biliary tree. Her most recent intervention had been the insertion of a SEMS, which was effective in preventing recurrent cholangitis over the year. On physical examination, she appeared to be fit, well-nourished and in no distress, with no pallor, jaundice or lymphadenopathy. An abdominal examination was unremarkable. Laboratory investigations were within normal limits, without any contraindications to endoscopy.

Spontaneous Fracture of a Covered Self-Expandable Biliary Metal Stent and Endoscopic Technique for Removal