Extrahepatic portomesenteric obstruction resulting in splanchnic hypertension and refractory ascites

Portal hypertension is a commonly described etiology that typically stems from underlying cirrhosis. Interventional radiologists may offer several interventions in the multidisciplinary approach to managing these patients. However, it is important to ascertain the cause and type of hypertension before intervention to avoid poor outcomes. We describe a case of an 89-year-old male with pancreatic adenocarcinoma and isolated superior mesenteric venous hypertension secondary to external stent compression at the portomesenteric confluence. This resulted in refractory ascites which was significantly relieved after portal to superior mesenteric vein stent placement.