Management of an inadvertent insertion of a biliary plastic stent into the portal vein: a dreaded ERCP adverse event.

BACKGROUND AND AIMS: Inadvertent insertion of a biliary stent into the portal vein is a rare but serious adverse event of ERCP, potentially leading to thrombosis, bleeding, and biliovascular fistula formation. Prompt recognition and multidisciplinary management are crucial to prevent severe outcomes. This case report aims to highlight a management approach of an inadvertent insertion of a biliary stent into the portal vein.

METHODS

A 52-year-old woman with a history of laparoscopic cholecystectomy developed a high-grade bile leak requiring ERCP with biliary stenting. She subsequently presented with worsening abdominal pain, and imaging confirmed misplacement of the biliary stent into the portal vein for which a multidisciplinary approach was used to effectively manage this adverse event. The stent was successfully removed, and the biliovascular fistula was closed using a hybrid percutaneous and endoscopic technique, avoiding vascular stenting and surgical intervention.

RESULTS

Biliovascular fistulas are a rare adverse event of bile duct injury and stenting. Early recognition is critical. Management requires a tailored approach, incorporating endoscopic, percutaneous, and anticoagulation strategies. In this case, the patient underwent a rendezvous approach involving advanced endoscopy and interventional radiology that subsequently led to fistula closure.

CONCLUSIONS

This case highlights the importance of early diagnosis and a multidisciplinary strategy in managing complex ERCP-related adverse events. A hybrid approach combining interventional radiology-guided techniques and endoscopic stenting proved effective in treating this rare but severe outcome.