Portal Vein Stent Placement: A Palliative Twist on an Old Concept

1Beth Israel Medical Center, New York, NY

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 410

Case Presentation:

A 71 year old female with a past medical history of diabetes, hypertension, and alcohol abuse presented with several months abdominal pain, increasing abdominal girth, weight loss and bilateral lower extremity swelling. An abdominal paracentesis demonstrated a transudative ascites without evidence of spontaneous bacterial peritonitis or malignant cells. An abdominal ultrasound revealed chronic pancreatitis and ascites. A CT scan of her abdomen/pelvis revealed extensive pelvic ascites with severe biliary duct dilatation. A gastrointestinal consultation was requested. An ERCP was performed and showed 2.5 cm proximal biliary ductal dilatation with an intra‐pancreatic biliary stricture. A pancreatic stent was placed. Endoscopic ultrasound demonstrated an enlarged calcified pancreatic head without evidence of common bile duct stones. Fine needle aspiration of the celiac node and pancreatic head confirmed ductal adenocarcinoma. During the course of her hospitalization, her ascites continued to worsen despite aggressive diuresis. A repeat CT scan showed a thrombus within the main and right portal veins and a severely calcified, atrophic heterogeneous pancreas without any discrete solid masses, intra or extra‐hepatic biliary dilation. There was no evidence of cirrhosis. Due to lack of clinical improvement with conservative medical management, a portal vein stent was placed by interventional radiology. There was marked improvement in ascites after stent placement. The patient was discharged home on oral diuretics.

Discussion:

Portal vein thrombosis (PVT) is an important cause of non‐cirrhotic portal hypertension. It often results from spontaneous thrombosis in hypercoagulable state, intrinsic obstruction from tumor or vascular trauma, or extrinsic compression by tumor, lymph nodes or inflammation. Acute thrombosis can present as infarct or ischemia, while chronic thrombosis can manifest as complications of portal hypertension such as ascites or variceal bleeding. Portal vein stenting results in a decrease in portal pressure leading to an improvement of ascites and variceal bleeding. Two different studies showed that portal vein stenting could alleviate symptoms related to portal hypertension in patients with hepatocellular carcinoma and pancreatic or biliary carcinoma. Similarly to our patient outcome, portal vein stenting has been shown to be an effective minimally invasive technique in improving portal hypertension complications such as ascites. Subsequent to stent placement, the patient symptomatically improved and her quality of life was enriched.

Conclusions:

PVT is a common finding in patients with malignancy. Many hospitalized patients often present with complications related to their malignancy; portal vein stenting is a modality that can be used for palliation of symptoms. Research should continue to investigate the efficacy and utility of this technique in order to help clinicians better manage these complicated patients.

To cite this abstract:

Favila D, Chernyavsky S. Portal Vein Stent Placement: A Palliative Twist on an Old Concept. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 410. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/portal-vein-stent-placement-a-palliative-twist-on-an-old-concept/. Accessed November 17, 2019.

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