Elsevier

Pancreatology

Volume 12, Issue 5, September–October 2012, Pages 463-465
Pancreatology

Case report
Pancreatic stent migration into the portal vein causing portal vein thrombosis: A rare complication of a prophylactic pancreatic stent

https://doi.org/10.1016/j.pan.2012.08.005Get rights and content

Abstract

This report describes the first case of a novel complication of prophylactic pancreatic stents used to reduce the risk of post-endoscopic retrograde cholangiopancreatography pancreatitis, whereby the stent migrated into the portal vein resulting in portal vein thrombosis. We review the literature and discuss the potential mechanisms that caused this complication. The approach and prompt treatment that resulted in a favorable clinical outcome are described.

Introduction

Pancreatic duct (PD) stents are used for a variety of pancreatic conditions including ductal obstruction from stricture or malignancy, ductal disruption, drainage of pancreatic pseudocysts, recurrent pancreatitis associated with pancreas divisum, obstructing ductal stones, and prevention of post-ERCP pancreatitis (PEP) [1]. Recently, there has been increased utilization of small diameter, unflanged, 3F–4Fr pancreatic stents to prevent PEP [2]. With increasing use of PD stents, recognized complications occur and include infection, bleeding, stent occlusion, pancreatitis, morphologic abnormalities of the PD (ductitis), duodenal erosions, ductal perforation, stent fracture, and migration of the stent proximally (upstream) or distally (downstream) [1].

Section snippets

Case report

A previously healthy 10-year-old female presented with 3 attacks of idiopathic acute pancreatitis over a year (each time abdominal pain associated with amylase and lipase greater than 3 times the upper limit of normal). Between these attacks she was asymptomatic. She had no evidence of diabetes or steatorrhea. CT scan revealed no pancreatic or hepatobiliary abnormalities and MRCP showed a normal pancreatic duct (PD) without evidence of pancreas divisum and a normal biliary tree. Liver function

Discussion

To our knowledge, this is the first reported human case of a PD stent migrating through the duct wall and parenchyma into the portal vein–splenic vein junction and causing portal vein thrombosis.

Proximal migration of endoscopic PD stents has been reported to occur at a rate approximating 5% [3] and the success for endoscopic retrieval is approximately 80% [4]. Retained PD stents may cause ductitis, strictures, chronic pancreatitis, stent occlusion and fragmentation [5]. Proximally migrated PD

Disclosure

All authors disclosed no financial relationships relevant to this publication.

Competing interests

None.

References (7)

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