Jejunal varix bleeding with extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy: report of two cases.
10.14701/kjhbps.2012.16.1.37
- Author:
Seung Duk LEE
1
;
Sang Jae PARK
;
Hyun Boem KIM
;
Sung Sik HAN
;
Seong Hoon KIM
;
Tae Suk YOU
;
Young Kyu KIM
;
Seong Yeon CHO
;
Soon Ae LEE
;
Young Hwan KO
;
Eun Kyung HONG
Author Information
1. Center for Liver Cancer, National Cancer Center, Goyang, Korea. spark@ncc.re.kr
- Publication Type:Case Report
- Keywords:
Jejunal varices;
Hepaticojejunostomy;
Portal vein stenosis;
Percutaneous transhepatic angioplasty;
Portocaval shunt
- MeSH:
Aged;
Anemia;
Constriction, Pathologic;
Dilatation;
Female;
Gastrointestinal Hemorrhage;
Hemorrhage;
Humans;
Melena;
Middle Aged;
Pancreaticoduodenectomy;
Portal Vein;
Portography;
Stents;
Varicose Veins
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2012;16(1):37-42
- CountryRepublic of Korea
- Language:English
-
Abstract:
We present 2 patients showing afferent jejunal varix bleeding around hepaticojejunostomy caused by extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy (PPPD). The case 1 was a 58-year-old woman who had recurrent anemia and hematochezia 3 years after undergoing PPPD. On the portography, the main portal vein was obliterated and collaterals around hepaticojejunostomy were developed. After percutaneous transhepatic balloon dilatation and stent placement through the obliterated portal vein, jejunal varices had disappeared and thereafter no bleeding occurred for 32 months. The case 2 was a 71-year-old man who had frequent melena 7 years after PPPD. Portal stent insertion was first tried, but failed due to severe stenosis of the main portal vein. Therefore, meso-caval shunt operation was attempted in order to reduce the variceal flow. Although an episode of a small amount of melena occurred one month after the shunt operation, there was no occurrence of bleeding for the next 8 months. For the treatment of jejunal varices, a less invasive approach, such as the angiographic intervention of stent insertion, balloon dilatation, or embolization is recommended first. Surgical operations, such as a shunt or resection of the jejunal rim, could be considered when noninvasive approaches have failed.
