A Rare Case of Inadvertent Insertion of a Plastic Biliary Stent Into the Main Portal Vein: A Serious Endoscopic Retrograde Cholangiopancreatography Complication After Liver Transplant.

Liver transplantation is the mainstay of treatment for end -stage liver disease. In this setting, endoscopic retrograde cholangiopancreatography is commonly used to assist T tube removal or to treat anastomotic biliary strictures. Iatrogenic portobiliary fistula is a rare but serious complication of endoscopic retrograde cholangiopancreatography, especially in the post-transplant setting. We describe the case of a 44 -year -old male patient with an iatrogenic Iatrogenic portobiliary fistula after an endoscopic retrograde cholangiopancreatography -assisted T tube removal and plastic biliary stent insertion. The plastic biliary stent was inadvertently and unknowingly inserted within the portal vein. Once identified, given the high probability of catastrophic bleeding or portal vein thrombosis, a combined surgical and endoscopic approach was chosen. The stent was endoscopically removed under direct control in the operating room, and the fistulous tract between the portal vein and the common bile duct was ligated and divided. This case highlights the critical risks of posttransplant endoscopic maneuvers and suggests that, unlike spontaneous fistulas, iatrogenic vascular damage might require an immediate combined surgical -endoscopic approach to guarantee vascular control and a safe outcome.