Biliary stents are commonly used for internal drainage of biliary obstruction, both malignant and benign. Intestinal perforation is a rare but potentially severe complication associated with plastic biliary stents. To date, this has been described exclusively in the setting of preceding stent migration. We present an unusual case of non-migrated biliary stent causing duodenal perforation which to our knowledge is the first described in the literature. A 65-year-old woman presented with three day history of malaise and severe right upper quadrant pain with associated fever and nausea. Her past medical history was notable for cholangiocarcinoma complicated by common bile duct obstruction requiring 10 Fr x 12cm plastic biliary stent placement with single external and internal flap 2 months prior. Physical exam was notable for tachycardia and right upper quadrant tenderness to palpation without rebound or guarding. Labs were notable for recurrent liver function tests (AST 154, ALT 280, AP 246, total bilirubin 0.9) above her prior baseline. CT abdomen and pelvis showed perforation of the second portion of the duodenum from the distal tip of the biliary stent with the proximal aspect of the stent remaining within the common bile duct (Figure 1, black arrow). She was started on antibiotics and underwent urgent EGD and ERCP. The plastic biliary stent was seen perforating through the wall of the duodenum opposite to the papilla and was removed via rat tooth forceps (Figure 2). An OVESCO clip was successfully used to close the perforation. A new 10 Fr by 10 cm plastic biliary stent with a full external pigtail and a ½ internal pigtail was placed in the left hepatic duct. At 3-month interval for scheduled stent exchange with an uncovered metal stent, her symptoms had significantly improved. The risk of perforation from endoscopically placed plastic biliary stents is extremely low, though it has been described in prior case reports. These reports have universally been reported in the setting of stent migration and perforation through the small bowel. This case illustrates a rare case of perforation from a non-migrated plastic biliary stent, and is the first in the literature to our knowledge. Our patient responded well to immediate endoscopic removal with closure of the duodenal wall defect via OVSCO clip and replacement of the stent with a new stent with external pigtail to prevent recurrent perforation.