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.
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

Introduction: Conference presentations are a very instructive experience for doctors.Aim: The aim of this study was to evaluate residents' attitude toward conference presentations.Methods: A questionnaire-based survey was conducted on 22 residents at our hospital, regarding their experience with giving a conference presentation.Results: Of the 22 residents, 15 (68%) completed the questionnaires. 13 (87%) of them had experienced giving a presentation for the first time. Overall, 14 (93%) of the 15 residents thought the experience of giving a conference presentation was very instructive. 12 residents (80%) wanted to experience it again. On the other hand, a few residents requested that giving a presentation be made voluntary and not mandatory.Conclusion: The results of our study demonstrates that giving conference presentations would be a very valuable experience for young doctors. The experience of giving a presentation coupled with prior explanations about its instructive value could positively impact intrinsic motivation.