Uncommon Malpositioned Inserted Biliary Stent Causing Common Bile Duct to Portal Vein Fistula: Case Report

Endoscopic biliary stent is a common practice in recent years. One of the complications might occur is stent malposition. A 31 years old male with obstructive jaundice secondary to gallstone, presented with persistent upper right quadrant abdominal pain immediately after biliary stenting. During evaluation, biliary stent was found in the portal vein, he immediately underwent repair laparoscopic converted to laparotomy due to obscured stent. Intraoperative findings include fistula in the common bile duct (CBD) to portal vein. Malposition of biliary stent is common occurrence. However, only 5% malposition to proximal and <1% cause perforation or fistula. Anatomical variation of extrahepatic biliary system is common and might be a contributing factor. Thus, adequate knowledge of the anatomical variation helps in stent placement and preventing associated complication. We report a rare case of CBD stent malposition to proximal portal vein with fistula.