Biliary stent migration complicated by sigmoid colon perforation with iliopsoas and acetabular involvement

Biliary stenting is a common treatment for obstructive jaundice in patients with benign or malignant biliary pathologies, particularly when surgical intervention is high-risk due to comorbidities. Although generally safe, stent-related complications can occur. They are typically classified as early or late. Stent migration is one such complication and is often asymptomatic. However, in rare instances it can lead to gastrointestinal perforation. We present a highly unusual case of a migrated biliary stent that perforated the sigmoid colon, traversed the lateral pelvic wall, and focally eroded the anterior acetabulum, resulting in acetabular erosion and an iliopsoas abscess. To our knowledge, this is the first reported case with such a trajectory and complication profile. Clinicians and radiologists should consider the possibility of stent-related gastrointestinal and even musculoskeletal involvement, particularly in patients presenting with unexplained pain and a history of biliary stenting.