Unintended Portal Venous Deployment of a Biliary Metallic Stent during Endoscopic Retrograde Cholangiopancreatography: Successful Management in a Rare Case

Abstract

Unintended portal venous deployment of a biliary stent during endoscopic retrograde cholangiopancreatography (ERCP) is a rare but life-threatening complication. We report the case of a 62-year-old woman with obstructive jaundice and a common bile duct stricture. Following multiple ERCPs at a secondary hospital, she was referred to our center, where the repeated ERCP revealed large intraluminal clots and a migrated metallic stent. Further evaluation with computed tomography angiography revealed a metallic stent inadvertently deployed into the portal vein. A multidisciplinary team, comprising gastroenterology, hepatobiliary surgery, and interventional radiology, coordinated a retrieval plan. During the procedure, stent removal precipitated massive portal venous hemorrhage through a fistulous tract into the duodenum. Hemostasis was successfully achieved via the immediate deployment of a covered VBX stent in the portal vein. This case highlights the need for early imaging and a multidisciplinary approach in managing severe ERCP-related vascular issues. It shows that a combined endoscopic-endovascular strategy, supported by prompt cross-sectional imaging, can successfully resolve such life-threatening complications.