Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy.
10.14701/kjhbps.2016.20.1.44
- Author:
Ikuo WATANOBE
1
;
Yuzuru ITO
;
Eigo AKIMOTO
;
Yuuki SEKINE
;
Yurie HARUYAMA
;
Kota AMEMIYA
;
Shozo MIYANO
;
Taijiro KOSAKA
;
Michio MACHIDA
;
Toshiaki KITABATAKE
;
Kuniaki KOJIMA
Author Information
1. Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan. nobei@juntendo.ac.jp
- Publication Type:Case Report
- Keywords:
Portal vein thrombosis;
Pancreaticoduodenectomy;
Late-onset hemorrhage;
Postoperative hemorrhage;
Postoperative pancreatic fistula
- MeSH:
Aged;
Duodenum;
Emergencies;
Hematemesis;
Hematoma;
Hemorrhage*;
Hemostasis;
Hepatic Artery*;
Humans;
Jejunum;
Necrosis;
Pancreatic Ducts;
Pancreaticoduodenectomy*;
Pancreaticojejunostomy;
Portal Vein*;
Postoperative Complications;
Postoperative Hemorrhage;
Stents;
Venous Thrombosis*;
Vital Signs
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016;20(1):44-47
- CountryRepublic of Korea
- Language:English
-
Abstract:
Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.
