Acute portal vein thrombosis and massive necrosis of the liver. An unusual complication after stenting for chronic pancreatitis.

CONTEXT: ERCP can provide information which is invaluable in managing chronic pancreatitis but it is associated with infrequent, although significant, complications and rare mortality. The complications uniquely associated with diagnostic ERCP include pancreatitis and sepsis (primary cholangitis).

CASE REPORT: A 32-year-old man presented with severe upper abdominal pain radiating to the back, associated with vomiting and abdominal distension. The patient was diagnosed as having had chronic calcific pancreatitis recently and had undergone ERCP with pancreatic duct stenting elsewhere. Two days after the procedure, the patient developed severe abdominal pain, vomiting and abdominal distention, and patient was referred to our hospital 7 days after the procedure. Investigation revealed massive liver necrosis and portal vein thrombosis. This patient had a life-threatening complication following pancreatic duct stenting for chronic pancreatitis and was managed medically.

CONCLUSION

Therapeutic pancreatic endoscopy procedures are technically demanding and should be restricted to high volume centers. There is a continuing need for evaluation and comparison with alternative strategies. In a good surgical candidate, it is better to avoid stenting.