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Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report

Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acu...

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Autores principales: Taşar, Pınar, Kılıçturgay, Sadık Ayhan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kare Publishing 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225845/
https://www.ncbi.nlm.nih.gov/pubmed/36880609
http://dx.doi.org/10.14744/tjtes.2022.28923
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author Taşar, Pınar
Kılıçturgay, Sadık Ayhan
author_facet Taşar, Pınar
Kılıçturgay, Sadık Ayhan
author_sort Taşar, Pınar
collection PubMed
description Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphincterotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4(th) post-operative day. On the magnetic resonance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5×5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient.
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spelling pubmed-102258452023-06-02 Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report Taşar, Pınar Kılıçturgay, Sadık Ayhan Ulus Travma Acil Cerrahi Derg Case Report Endoscopic retrograde cholangiopancreatography (ERCP) has been a widely used procedure in the diagnosis and treatment of various pancreaticobiliary disorders. Although widely considered a safe procedure, ERCP is associated morbidity and occasional mortality. The most common complications include acute pancreatitis, hemorrhage, and duodenal perforation. Portal vein cannulation is a rare complication of ERCP. We described a case of placement of an endoscopic biliary stent in the portal vein during ERCP and sphincterotomy. A 54-year-old female patient underwent laparoscopic cholecystectomy with a pre-diagnosis of chronic cholecystitis with gallstones. She visited emergency unit with the complaint of jaundice and itching on the 4(th) post-operative day. On the magnetic resonance cholangiopancreatography, the intrahepatic and the extrahepatic bile ducts were dilated and a 7.5×5.5 mm stone at common bile duct. Sphincterotomy was performed by ERCP, the stones were removed, and then a 10F 7 cm stent was installed. Abdominopelvic computed tomography (CT) was performed on the 4th day of ERCP in the patient whose fever and total bilirubin levels persisted at 5 mg/dL, considering cholangitic abscess and/or ERCP complication. On the CT, the proximal end of the stent in the common bile duct was observed to enter into the main portal vein and the tip was observed to be thrombosed. Therefore, it was decided to remove the stent endoscopically under operating room conditions. After the anesthesia induction, the stent was endoscopically removed by the gastroenterology team. The abdominal cavity of patient was explored laparoscopically in the during of stent removal. The patient did not experience hemodynamic instability and did not require transfusion during anesthesia but had melena once on the clinical follow-up. The patient was discharged with low molecular weight heparin and oral cephalosporin and was advised to return for polyclinic control. Doppler ultrasonography (USG) was performed to evaluate the thrombosis of the portal vein in the patient who had intermittent fever during the controls. Doppler USG revealed a thrombosed appearance in the main portal vein and its branches. The patient, who was in good general condition and had no abdominal pain, was switched to high-dose low molecular weight heparin and followed under the control of the gastroenterology and general surgery outpatient clinic. This rare life-threatening complication should always be kept in mind especially during the procedure and/or in the clinical follow-up of the patient. Kare Publishing 2023-03-01 /pmc/articles/PMC10225845/ /pubmed/36880609 http://dx.doi.org/10.14744/tjtes.2022.28923 Text en Copyright © 2023 Turkish Journal of Trauma and Emergency Surgery https://creativecommons.org/licenses/by-nc/4.0/This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
spellingShingle Case Report
Taşar, Pınar
Kılıçturgay, Sadık Ayhan
Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title_full Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title_fullStr Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title_full_unstemmed Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title_short Portal vein injury following endoscopic retrograde cholangiopancreatography: A case report
title_sort portal vein injury following endoscopic retrograde cholangiopancreatography: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10225845/
https://www.ncbi.nlm.nih.gov/pubmed/36880609
http://dx.doi.org/10.14744/tjtes.2022.28923
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