Recognition and Management of Stent Malposition in the Portal Vein During Endoscopic Retrograde Cholangiopancreatography: A Case Report

Overview

Journal World J Gastrointest Endosc

Publisher Baishideng Publishing Group

Date 2024 Jul 29

PMID 39072250

Authors

Rui Wu

Feng Zhang

Hao Zhu

Ming-Dong Liu

Yu-Zheng Zhuge

Lei Wang

Bin Zhang

Affiliations

Soon will be listed here.

Abstract

Background: Portal vein injury is an uncommon complication of endoscopic retrograde cholangiopancreatography (ERCP), for which stent malpositioning in the portal vein is very rare and can lead to fatal events. We report a case of biliary stent migration to the portal vein and a novel method for its safe removal under the guidance of portal angiography. Moreover, we reviewed the literature and summarized reports on the identification and management of this condition.

Case Summary: A 59-year-old woman with pancreatic cancer presented with abdominal pain and a high fever 20 days after the placement of two plastic biliary stents under the guidance of ERCP. Blood cultures and laboratory tests revealed sepsis, which was treated with antibiotics. A contrast-enhanced computed tomography scan revealed that one of the biliary stents in the main portal vein was malpositioned. To safely remove the stent, portal angiography was performed to visualize the portal vein and to allow the management of any bleeding. The two stents were removed without obvious bleeding, and an uncovered self-expanding metal stent was placed in the common bile duct for drainage. The patient had an uneventful 6-month follow-up period, except for self-resolving portal vein thrombosis.

Conclusion: The combination of endoscopic and angiographic techniques allowed uneventful management of stent malposition in the portal vein.

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