Management of Portal Vein Thrombosis and Porto-enteric Fistula Following Whipple Procedure: A Multimodal Interventional Approach

Portal vein thrombosis with porto-enteric fistula is a rare but serious complication after Whipple procedure. This case report describes the management of a 65-year-old female who developed this complication following a Whipple procedure for pancreatic adenocarcinoma. Interventional radiology (IR) techniques, including mechanical thrombectomy, transjugular intrahepatic portosystemic shunt (TIPS) creation, and covered stent deployment across the fistula, successfully addressed the complex pathology. Despite challenging complications and subsequent TIPS revisions, the interventions successfully restored vascular patency and decompressed the portal system, ultimately sealing the fistula. However, recurrent thrombosis remained a challenge, and the patient ultimately died from complications of her underlying illness, underscoring that technical success may not always translate to durable clinical recovery in this population. This case highlights the critical role of IR in managing complex vascular complications, particularly in patients after Whipple procedure, where surgical reintervention is associated with a high mortality rate.