Internal drainage with endoscopically placed endoprostheses is an established management strategy for biliary tract obstruction. The method is preferred over surgical drainage because of the significantly lower complication rate [1]. Complications after stent placement are rare and include cholangitis, cholecystitis, bile duct erosion, pancreatitis, stent occlusion, stent fracture, stent migration, and intestinal impaction [1, 2] Intestinal perforation is perhaps the rarest complication of endoscopic biliary stenting, with sporadically published reports [2][3][4]. The perforation is typically caused by a very long and rigid stent impacted in the duodenum [2,3]. Distal perforations involving the small bowel [2] or colon [4] are among the most unexpected life-threatening abdominal emergencies.

When patients with end-stage renal disease have exhausted both conventional and unconventional venous access options, creative solutions must be sought for hemodialysis catheter placement in order to ensure survival. This case describes a patient in urgent need of a dialysis catheter despite total occlusion of the jugular, subclavian, and femoral veins. Occlusion of the inferior vena cava (IVC) and right renal vein resulted in failed attempts at translumbar catheter placement. A gooseneck snare was temporarily advanced through the liver to the IVC for use as a fluoroscopic target to facilitate successful single-puncture, translumbar catheterization.

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