Skip Navigation
Skip to contents

Clin Endosc : Clinical Endoscopy

Search
Advanced Search
OPEN ACCESS
mobile search button mobile menu button

Articles

Page Path
HOME > Clin Endosc > Volume 58(2); 2025 > Article
Image of Issue Refractory duodenal ulcer caused by portal stent graft exposure
Gil Ho Leeorcid, Choong-Kyun Nohorcid, Kee Myung Leeorcid
Clinical Endoscopy 2025;58(2):320-321.
DOI: https://doi.org/10.5946/ce.2024.232
Published online: January 14, 2025

Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea

Correspondence: Choong-Kyun Noh Department of Gastroenterology, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 16499, Korea E-mail: cknoh23@gmail.com
• Received: August 27, 2024   • Revised: September 30, 2024   • Accepted: October 1, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

  • 576 Views
  • 120 Download
prev next
Full Article

Download PDF Download PDF

A 68-year-old man presented with recurrent melena for 1 year. A 9.6-cm-sized cholangiocarcinoma in the right liver lobe was identified 2 years prior, and the patient underwent right trisectionectomy with caudate lobectomy. Postoperative doppler ultrasonography and computed tomography (CT) demonstrated narrowing of the portal vein anastomosis site, and stent insertion was performed. He had no history of medication use, including nonsteroidal anti-inflammatory and anti-acid drugs. However, 1 year postoperatively, he was re-admitted to an emergency center with hematemesis. Upper endoscopy revealed an active ulcer and exposed vessels in the duodenal bulb (Fig. 1A). Bleeding was controlled by hemoclipping, and rapid urease test results were negative. The patient experienced intermittent, small-volume melena 8 months after bleeding control, and endoscopic evaluation was performed again. The ulceration persisted in the duodenal bulb, and a metallic material was observed, which was suspected to be stent exposure (Fig. 1B). A recent CT scan confirmed complete thrombotic occlusion of the portal vein stent, and it was determined that the previous surgery resulted in adhesion between the stent and duodenum (Fig. 2). The ulcer worsened due to portal stent exposure. The patient was treated conservatively and was discharged with ulcer medications. A follow-up endoscopy revealed an almost completely healed ulceration (Fig. 3).
Stent migration into the gastrointestinal tract can cause recurrent bleeding,1,2 and portal venous stent migration into the duodenum following liver resection is rare. If repeated duodenal ulcerations persist, with or without stent exposure, the cause should be assessed. Conservative treatment may be more effective, compared with stent removal. Herein, we describe an extremely rare case of refractory duodenal ulcer caused by portal stent exposure.
Fig. 1.
(A) Active ulceration with an exposed vessel in the duodenal bulb. (B) Metallic stent exposure at the base of the ulcer (arrow: exposed portal stent).
ce-2024-232f1.jpg
Fig. 2.
Complete thrombotic occlusion of the portal vein stent graft with duodenal penetration on computed tomography (arrow: portal stent).
ce-2024-232f2.jpg
Fig. 3.
Healed ulceration on follow-up endoscopy.
ce-2024-232f3.jpg
  • 1. Garcia-Alonso FJ, Sanchez-Ocana R, Peñas-Herrero I, et al. Cumulative risks of stent migration and gastrointestinal bleeding in patients with lumen-apposing metal stents. Endoscopy 2018;50:386–395.ArticlePubMed
  • 2. Hong S, Kim GH. Aortoduodenal fistula bleeding caused by an aortic stent graft. Clin Endosc 2024;57:407–408.ArticlePubMedPMCPDF

Figure & Data

REFERENCES

    Citations

    Citations to this article as recorded by  

      • PubReader PubReader
      • ePub LinkePub Link
      • Cite
        CITE
        export Copy Download
        Close
        Download Citation
        Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.
        Format:
        • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
        • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
        Include:
        • Citation for the content below
        Refractory duodenal ulcer caused by portal stent graft exposure
        Clin Endosc. 2025;58(2):320-321.   Published online January 14, 2025
        DOI: https://doi.org/10.5946/ce.2024.232
        Close
      • XML DownloadXML Download
      Figure
      • 0
      • 1
      • 2
      Related articles
      Refractory duodenal ulcer caused by portal stent graft exposure
      Image Image Image
      Fig. 1. (A) Active ulceration with an exposed vessel in the duodenal bulb. (B) Metallic stent exposure at the base of the ulcer (arrow: exposed portal stent).
      Fig. 2. Complete thrombotic occlusion of the portal vein stent graft with duodenal penetration on computed tomography (arrow: portal stent).
      Fig. 3. Healed ulceration on follow-up endoscopy.

      Fig. 1.

      Fig. 2.

      Fig. 3.

      Refractory duodenal ulcer caused by portal stent graft exposure
      Clin Endosc : Clinical Endoscopy Twitter Facebook
      © Korean Society of Gastrointestinal Endoscopy.
      Close layer
      TOP