[Porto-Biliary-Enteric Fistula after Portal Vein Stenting for Stenosis Following Pancreaticoduodenectomy-A Case...

A female in her 70s, who underwent pancreaticoduodenectomy for pancreatic head carcinoma after preoperative chemoradiotherapy, developed ascites and portal vein stenosis 5 months after the surgery, necessitating metallic stent placement. Four years after stent placement, recurrent gastrointestinal bleeding prompted a CT scan that revealed in-stent thrombosis. Portography confirmed contrast extravasation from the distal end of the stent into the bile duct and jejunum, establishing the diagnosis of a fistula. Sclerotherapy of the superior mesenteric vein varices combined with covered stent redeployment, which addressed both in-stent stenosis and the fistula, resulted in resolution of the portal vein stenosis and cessation of bleeding. Ten months post-procedure, the patient still remains asymptomatic. Portal vein stenting complications, particularly portal-choledochojejunostomy fistulae, are exceedingly rare, but are potentially fatal. This case highlights the importance of considering this rare complication in patients with recurrent gastrointestinal bleeding following portal vein stenting.