Interventional Radiology - Technical Note

Malpositioned endoscopically inserted biliary stent causing massive hematemesis managed with vascular plug and stenting

10.5152/dir.2021.20776

  • Mark A. Reddick
  • Andrew J. Ceranske
  • Peiman Habibollahi

Received Date: 18.09.2020 Accepted Date: 17.11.2020 Diagn Interv Radiol 2021;27(6):789-791

A 46-year-old man with a history of hepatitis B cirrhosis and hepatocellular carcinoma (HCC) status post liver transplantation two years ago complicated by HCC recurrence and biliary stenosis presented with hypovolemic shock and melena one month after endoscopic exchange of plastic biliary stents. During endoscopic retrograde cholangiopancreatography, patient was found to have hemobilia and developed uncontrollable bleeding after a common bile duct (CBD) sweep managed by insertion of a stent-graft across major papilla into presumed CBD. The bleeding continued with subsequent negative angiography, and a computed tomography angiography showed malpositioned stent-graft between major papilla and inferior vena cava (IVC). This was successfully managed by the deployment of a vascular plug inside the stent graft and excluding it by deploying a stent across the affected area in IVC.