Portal vein stenting in the management of duodenal varices due to malignant obstruction: A case report and literature review

INTRODUCTION AND IMPORTANCE: Ectopic varices of the small bowel are a rare complication of portal hypertension. There are various aetiologies that can cause portal vein hypertension such as portal vein obstruction. Each of these pathologies has their own management strategies. Currently, there is a paucity of literature demonstrating the best management for patients with malignant portal vein obstruction leading to these varices. CASE PRESENTATION: This report presents a case of a 66-year-old female who presented with recurrent per-rectal bleeding. Computed tomography angiography diagnosed duodenal varices in the context of malignant obstruction of the portal vein. Due to being a poor operative candidate, she underwent trans-hepatic portal vein stenting leading to resolution of her symptoms. CLINICAL DISCUSSION: To date, the management of portal vein obstruction due to various aetiologies has only been reported in case reports with no significant large-scale studies providing recommendations on the most appropriate treatment. This case demonstrates the role of palliative stenting for patients with portal hypertension due to malignant portal vein obstruction. CONCLUSION: Duodenal varices are a rare complication of portal vein obstruction. This article contributes to the literature by demonstrating that patients with complications associated with portal vein obstruction can benefit from stenting. For those with malignant obstruction, palliative stenting serves as an important therapeutic option.