Wu R, Zhang F, Zhu H, Liu MD, Zhuge YZ, Wang L, Zhang B. Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report. World J Gastrointest Endosc 2024; 16(7): 432-438 [DOI: 10.4253/wjge.v16.i7.432]
Corresponding Author of This Article
Bin Zhang, MD, PhD, Associate Professor, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. billzhangnju@foxmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jul 16, 2024; 16(7): 432-438 Published online Jul 16, 2024. doi: 10.4253/wjge.v16.i7.432
Recognition and management of stent malposition in the portal vein during endoscopic retrograde cholangiopancreatography: A case report
Rui Wu, Feng Zhang, Hao Zhu, Ming-Dong Liu, Yu-Zheng Zhuge, Lei Wang, Bin Zhang
Rui Wu, Feng Zhang, Hao Zhu, Ming-Dong Liu, Yu-Zheng Zhuge, Lei Wang, Bin Zhang, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
Author contributions: Zhang B, Wang L, and Zhuge YZ helped conceptualize and supervise the study; Zhang B, Zhang F, Zhu H, and Liu MD helped collect data; Wu R and Zhang B helped analyze the data; Wu R, Zhang B, Zhu H, and Liu MD helped review the literature; Wu R helped draft the manuscript; and all the authors helped revise the manuscript and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bin Zhang, MD, PhD, Associate Professor, Department of Gastroenterology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu Province, China. billzhangnju@foxmail.com
Received: May 2, 2024 Revised: May 30, 2024 Accepted: June 27, 2024 Published online: July 16, 2024 Processing time: 66 Days and 23.2 Hours
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.
Core Tip: Stent malpositioning in the portal vein is a very rare complication of endoscopic retrograde cholangiopancreatography and can be fatal. We report a case of stent migration into the portal vein and a novel method for its safe removal under the surveillance of portal angiography. After reviewing the literature, we summarized the characteristics of reported cases, including predisposing factors and manifestations of stent malposition in the portal vein, and other treatments, such as immediate stent removal, metal stent placement in the bile duct, urgent surgery, and covered stent placement in the portal vein.
