Bleeding From Unintentional Portal Vein Stenting During Endoscopic Retrograde Cholangiopancreatography Managed With Portal Vein Stent Graft Placement—A Case Report With a Detailed Review of the Literature

Suspicion of vascular injury during endoscopic retrograde cholangiopancreatography (ERCP) should be raised in the event of intraprocedural bleeding, persistent hyperbilirubinemia, and sepsis despite biliary stenting. Most inadvertent portal vein (PV) cannulations during ERCP are innocuous, and mere withdrawal of guidewire and catheter suffices. However, unintentional PV stenting, particularly with larger metallic stents, increases the likelihood of significant bleeding. Thus, endoscopic removal of a malpositioned stent from the PV should be carried out in the interventional radiology suite so that PV stent grafting can be performed in case of unexpected bleeding. Here, we describe a case of bleeding from a malpositioned 10-French plastic stent within the PV during ERCP in a 79-year-old male. The bleeding was effectively controlled by inserting a 16-mm covered stent into the PV via a transjugular route.