Percutaneous stenting of the portal vein prior to biliary bypass in a patient with chronic pancreatitis and portal biliopathy.

Chronic pancreatitis (CP) often leads to obstruction of one or all the components of the spleno-mesenterico-portal (SMP) axis. This is often due to the ongoing inflammatory process which may lead to thrombosis of the surrounding veins. However, the inflammation also leads to progressive fibrosis and occlusion of the veins without thrombosis. This fibrosis is also responsible for the duodenal obstruction and biliary strictures associated with CP. These patients, with simple occlusion or encasement of one or a combination of components of the SMP axis, can be treated with venous stenting. Here, we present the case of a 58-year-old gentleman with portal vein occlusion and portal biliopathy secondary to CP. This patient was successfully treated with percutaneous transhepatic portal vein stenting and a subsequent surgical biliary bypass. In conclusion, portal venous obstruction in CP may be just due to local fibrosis and is amenable to treatment with a percutaneously placed portal venous stent.