Duodenal perforation is an uncommon but potentially fatal complication of pancreatic surgery. We report a 73-year-old man who presented with hematochezia after laparoscopic distal pancreatectomy with splenectomy for pancreatic body cancer, complicated by a postoperative pancreatic fistula that led to gastroduodenal artery bleeding treated with a stent-graft. Contrast-enhanced CT showed active duodenal bleeding with a surrounding hematoma. The bleeding duodenal branch was embolized, and the hematoma was drained percutaneously; a fistulous communication between the periduodenal collection and the duodenal lumen was subsequently demonstrated. Through the drainage tract, an 8-Fr Foley catheter was advanced into the duodenal lumen and its balloon inflated to secure a controlled fistula, while a percutaneous gastrojejunostomy provided distal enteral feeding. The catheter was maintained for approximately 2 months, and the tract was embolized at the time of removal to minimize residual leakage. The patient recovered fully. This case demonstrates the feasibility of staged interventional management for postoperative duodenal perforation when reoperation is not feasible.

Acute SVC syndrome caused by extensive thrombosis requires prompt endovascular intervention. We report a 48-year-old female with colon cancer presenting with massive chemoport-related thrombosis involving the SVC, right atrium (RA), and bilateral brachiocephalic veins. Due to the lack of an embolic protection filter landing zone, we performed a novel plug-assisted thrombectomy (PAT) technique. A 20-mm vascular plug was positioned at the SVC-RA junction as a temporary tethered filter without detachment. Following mechanical thrombectomy, plug retrieval, and adjunctive balloon dilatation, the patient recovered and was discharged on day 12. This case demonstrates the technical feasibility of PAT as a proof-of-concept approach for embolic protection in patients with extensive SVC thrombosis where conventional filter placement is anatomically precluded.

We report a 54‑year‑old woman with chronic pancreatitis, duodenal obstruction, massive ascites, and refractory thrombocytopenia who developed septic obstructive cholangitis after occlusion of a plastic common bile duct (CBD) stent. Endoscopic exchange failed and PTBD was prohibitively risky. Transjugular intrahepatic biliary stenting (TIBS) provides an alternative route that avoids transperitoneal hepatic capsule puncture. Via right internal jugular access, the right hepatic vein was catheterized, a posterior sectoral bile duct punctured, and a guidewire crossed the distal CBD stricture. A 12 × 80 mm self‑expandable metallic stent was deployed and the transhepatic tract embolized with coils. The patient experienced rapid clinical and biochemical recovery (bilirubin, 13.3 to 1.37 mg/dL) over 9 days postprocedure without any hemorrhagic complications. TIBS is a decisive, life‑saving alternative when standard routes are not possible.

Suture-mediated vascular closure devices (SMVCD) can be applied to close non-vascular structures, although this represents an off-label use. A 53-year-old woman who underwent hysterectomy and chemoradiation therapy due to endometrioid adenocarcinoma two years ago presented for generalized peritonitis due to anastomotic perforation following adhesiolysis and resection. CT revealed multifocal peritoneal abscesses. During perigastric fluid drainage, a pigtail drainage catheter was inadvertently placed into the stomach. To reduce the risk of gastroperitoneal fistula and peritonitis, the gastrostomy site was percutaneously closed using an SMVCD. Immediately after closure, gastrography using orally administered contrast medium and a 10-month follow-up CT demonstrated no leakage or procedure-related complications. This case suggests the potential for safe off-label use of vascular closure devices in the closure of gastrointestinal tract punctures.