Post written by Rashid Abdel-Razeq, MD, and Hassan Siddiki, MD, MS, MEd, from Cleveland Clinic Foundation, Cleveland, Ohio, USA.

This article describes a case of an inadvertent biliary stent insertion into the portal vein. A multidisciplinary hybrid endoscopic and percutaneous approach successfully removed the stent and closed the biliovascular fistula without surgical intervention.

It was important to showcase this video because it demonstrates a rare and potentially life-threatening ERCP adverse event that was managed successfully through early recognition and a coordinated multidisciplinary approach. The case emphasizes how a hybrid endoscopic and percutaneous technique can effectively treat a complex biliovascular fistula while avoiding surgical intervention, offering valuable insight for managing similar scenarios.

A multidisciplinary team should guide management using venography and cholangiography to confirm a portobiliary fistula. Stent removal can be performed safely with a rendezvous approach involving interventional radiology, and transpapillary bile duct stenting is preferred over vascular stenting to minimize infection risk.

Computed tomography scan of the abdomen, coronal view, showing inadvertent stent insertion to the portal vein (circled).

Read the full article online.

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