Off-label use of a WRAPSODYTM stent-graft in the portal vein for septic gas embolism following pancreatic abscess fistulization: a case report.

BACKGROUND

Portal venous gas embolism resulting from fistulizing pancreatic abscesses is exceedingly rare and life-threatening. Management is further complicated when associated with portal vein thrombosis, and no dedicated stent-grafts exist for portal venous reconstruction. Exclusion of the fistulous communication is necessary to prevent ongoing septic embolization.

CASE DESCRIPTION: A 58-year-old male with chronic pancreatitis and prior distal pancreatectomy developed septic portal venous gas embolism due to fistulous communication between a postoperative pancreatic abscess and the portal venous confluence. In the setting of progressive gas embolization and increasing thrombus burden, percutaneous transhepatic endovascular reconstruction was performed. A fully covered WRAPSODYTM stent-graft was deployed to seal the fistulous tract, followed by a balloon-expandable Bentley BeGraftTM to extend coverage and exclude residual mural thrombus.

CONCLUSIONS

Portal venous flow was immediately restored with complete exclusion of the fistulous tract. The patient demonstrated rapid clinical improvement without complications. Follow-up computed tomography (CT) confirmed durable stent patency, resolution of portal venous gas, and regression of thrombus. The WRAPSODYTM stent-graft's trilaminar proprietary trilaminar membrane (PTFE) membrane and high flexibility enabled effective exclusion of a septic portal vein fistula in a complex postoperative setting. Based on a focused review of indexed literature, no prior reports describing WRAPSODYTM stent-graft implantation in the portal venous system were identified. Although further experience is required, this case illustrates a novel off-label application for life threatening portal venous pathology, demonstrating technical feasibility and short-term success.