Endoscopic stent placement has become a well-established treatment in the management of biliary tract obstruction8. Complications such as pancreatitis, hemorrhage, duodenal perforation, or cholangitis can occur in up to 10% of insertions4,6,8. Iatrogenic perforation of the portal vein during the procedure or stent migration to the portal system are unusual complications, and due to scarce reports in the literature, there is no consensus on how to manage it1,2,11.
Here, we present a case of portal thrombosis secondary to an accidental portal insertion of a biliary stent. The study was approved by the Ethics Committee of the Institution (number 76693423.1.0000.0068).
A 44-year-old female presented in another medical institution with acute upper abdominal pain, jaundice, and vomiting, and was diagnosed with mild acute biliary pancreatitis. Magnetic resonance imaging (MRI) showed choledocholithiasis. As the jaundice persisted, she underwent endoscopic retrograde cholangiopancreatography (ERCP). After undergoing papillotomy and plastic stent placement, the clinical jaundice subsided. The clinical report did not mention technical difficulties.
After 4 months, the patient was referred to our outpatient facility due to upper abdominal pain and generalized pruritus. Blood tests showed: total bilirubin, 2.06 mg/dL (reference range, 0.2-1.2 mg/dL); direct bilirubin, 1.0 mg/dL (up to 0.5 mg/dL); indirect bilirubin, 1.1 mg/dL (0.2-0.7 mg/dL); alkaline phosphatase, 270 U/L (40-150 U/L), and gamma-glutamyl transferase, 431 U/L (12-64U/L).
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