A Case of Extrahepatic Portal Venous Obstruction after 8 Years Pancreaticoduodenectomy Effectively Treated with Transjuguler Intrahepatic Portoplasty

Yuichi Nakasato, Yoshinori Inagaki, Kimiyoshi Mizunuma*, Katsuhide Sano, Tokuyasu Yokota, Kazuro Tanaka, Kosuke Takeuchi, Yasuro Futagawa, Teruaki Aoki

Department of Surgery, Jikei Univesity School of Medicine
*Department of Radiology, Jikei University School of Medicine

A 78-year-old man, who had been operated on by the Child procedure for inferior bile duct carcinoma eight year earlier, was admitted to the hospital because of melena with portal hypertension. Enhancement-CT and portogram of celiac angiography revealed a tortuous and bent portal trunk with prehepatic portal hypertension and hepatofugal collateral circulation. There was no evidence of recurrence of the previous carcinoma. Transjugular intrahepatic balloon angioplasty was performed to dilate the stenosis of the portal trunk, but it did not have a sufficient effect on the stenosis. Therefore, a l0-mm, self-expandable metalic stent (wallstent^®) was implanted, creating a nearly normal lumen without a pressure gradient. This procedure is transjuguler intrahepatic portoplasty (TIPP). After TIPP for the stenosed portal trunk, portal hypertension was relieved and there was no opacification of the collateral vessels. In the post-TIPP state, maximal velocity was decreased but flow volume was increased at the portal trunk as compared with the pre-TIPP state. The patient's clinical course was satisfactory and he was discharged on the 11th post-TIPP day. The patient had no recurrent melena and anemia for 20 months after this procedure. This procedure was considered useful for the portal obstruction, and this case was the 1st case of TIPP in Japan.

Key words
transjugular intrahepatic portoplasty, prehepatic portal vein obstruction, selfexpandable metalic stent

Reprint requests
Yuichi Nakasato Department of Surgery, Jikei University School of Medicine
3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105 JAPAN

Accepted
March 19, 1997

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