Portal-Vein Compression Caused by Double-Pigtail Plastic Biliary Stent

Area of Science:

• Gastroenterology
• Interventional Radiology
• Vascular Surgery

Background:

• Pseudoaneurysms, particularly hepatic pseudoaneurysms, are increasingly reported following biliary stent placement.
• Double pigtail plastic stents (DPS) have been linked to hepatic pseudoaneurysm rupture, often diagnosed late due to non-specific symptoms.

Purpose of the Study:

• To report a case of portal vein compression by a double pigtail plastic biliary stent.
• To highlight the importance of early detection and intervention to prevent severe vascular complications.

Main Methods:

• A 45-year-old woman with pancreatic cancer underwent endoscopic retrograde cholangiopancreatography (ERCP) with DPS placement for obstructive jaundice.
• Follow-up contrast-enhanced computed tomography (CE-CT) and 3D-CT identified left portal vein stenosis caused by the DPS.
• The DPS was replaced with a straight-type stent.

Main Results:

• The DPS caused compression and stenosis of the left portal vein branch.
• Replacement with a straight-type stent successfully relieved the compression.
• The patient avoided complications such as pseudoaneurysm formation, rupture, embolism, or thrombosis.

Conclusions:

• Portal vein compression is a potential complication of double pigtail plastic biliary stents.
• Prompt recognition of vascular changes on imaging and timely stent exchange can prevent serious vascular events.