[A patient with middle bile duct cancer who showed rapid obstruction on contrast radiographs 1 week after insertion of a non-covered stent, but this case obtained a long-term stent opening and long survival after re-insertion of a covered stent].

A 73-year-old female with jaundice was referred to our department and admitted. Blood examination on admission showed an abnormal liver function and an increase in CA19-9. Ultrasonography of the abdomen revealed a well-delineated round mass in the middle bile duct. After admission, PTBD was performed, and a complete obstruction was observed in the middle bile duct. Cytological examination of the bile demonstrated adenocarcinoma. Based on these findings, a diagnosis of middle bile duct cancer was made. Because of delirium and frequent wandering during the night due to dementia, a radical operation was abandoned, and a non-covered stent was placed. However, since 1 week after insertion of a non-covered stent, contrast radiography showed tumor protrusion (rapid obstruction) in the stent, and a covered stent was placed in the stent. The stent was open for 486 days after stent re-insertion. PTBD was performed for re-obstruction, but she died 596 days after admission. In patients for whom surgery is impossible for reasons other than tumor factors, internal fistula construction using a metallic stent, which neither impairs QOL nor shorten survival, can be indicated.