Colonic hemorrhage due to biliary stent migration mistaken for recurrent hemobilia

Endoscopic biliary stenting is a well-established therapeutic option for biliary decompression in patients with a high operative risk. One of the major drawbacks of the procedure is distal migration. We present a patient who suffered from two episodes of gastrointestinal bleeding after biliary endoprosthesis placement. In the first episode, bloody stool passage occurred 1 day after the procedure. Hemobilia was diagnosed after endoscopic study. The bleeding source in the second episode, however, was later found to be erosion in the ascending colon as a late sequela of stent migration. The signs and symptoms in the two different-source bleeding episodes occurred consecutively, and were clinically similar. Therefore, the differential diagnosis in such a case might be difficult. Only with a high index of suspicion, which we used in this case, can the prompt diagnosis and optimal treatment be achieved.