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Biliary stenting is a therapeutic procedure whereby a metal or plastic tube is inserted into a blocked bile duct via endoscopic retrograde cholangiopancreatography (ERCP). Indications include biliary drainage (short term) and palliation of malignant common bile duct (CBD) obstruction (long term). 1 Distal stent migration occurs in approximately 6% of cases.2 3 While most cases are asymptomatic, biliary stent perforation of both the small and large bowel has been previously described.4–7 We describe a rare case of parastomal abscess formation following biliary stent migration and perforation through an end ileostomy, masquerading as a parastomal hernia—to our knowledge the first such case in published literature.