Diagnostic and Interventional Radiology
Interventional Radiology - Technical Note

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

1.

Division of Vascular and Interventional Radiology, Department of Radiology, UT Southwestern Medical Center, Texas, USA

2.

Department of Interventional Radiology, MD Anderson Cancer Center, Houston, Texas, USA

Diagn Interv Radiol 2020; 1: -
Read: 234 Published: 26 November 2020

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 ERCP patient was found to have haemobilia 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 CTA showed mispositioned stent-graft between major papilla and 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.

EISSN 1305-3612