A Case of Jejunal Varices with Extrahepatic Portal Obstruction Successfully Treated with Embolization of Varices by a Transmesenteric Approach

Tsutomu Sato, Yoshihiro Asanuma, Manabu Hashimoto*, Satoshi Shibata, Toshiki Kikuchi, Hideaki Andoh, Kenji Koyama

First Department of Surgery, *Department of Radiology, Akita University School of Medicine

A case of gastrointestinal bleeding from jejunal varices with extrahepatic portal obstruction was successfully treated by embolization of the varices by a transmesenteric approach under laparotomy. A 67-year-old man who had undergone pancreatoduodenectomy five months earlier for lower bile duct cancer was admitted to our hospital with massive gastrointestinal bleeding and hepatic coma. The hepatic coma was treated by continuous arteriovenous hemofiltration; however, massive gastrointestinal bleeding occurred again five months later. Angiography and color Doppler ultrasonography revealed the presence of extrahepatic portal obstruction and two streaks of hepatopetal collateral vessels which formed jejunal varices around the hepaticojejunostomy. Embolization of jejunal varices by a radiologic interventional technique was performed twice through the mesenteric vein following intraoperative portography. Bleeding has not recurred during the two years after the procedure. Embolization of varices is one of the useful therapeutic tools for gastrointestinal bleeding from ectopic varices.

Key words
extrahepatic portal obstruction, jejunal varices, interventional radiology

Reprint requests
Tsutomu Sato First Department of Surgery, Akita University School of Medicine
1-1-1 Hondo, Akita, 010 JAPAN

Accepted
September 11, 1996

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