Successful Treatment with an Expandable Metallic Stent of Gastrointestinal Bleeding Resulting from Anastomotic Stricture in the Reconstructed Region of the Portal Vein: A Case Report

Nobusada Koike, Takashi Hatori, Toshihide Imaizumi, Nobuhiko Harada, Akira Fukuda and Ken Takasaki

Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University

In February 1995, a 39-year-old woman underwent pylorus-preserving pancreaticoduodenectomy (PpPD) combined with coresection of the portal vein for a nonfunctioning endocrine tumor of the pancreas with suspected of the portal vein invasion. Although her clinical course was favorable, she reported tarry stools in July 1995. Abdominal angiography showed anastomotic obstruction of the portal vein and numerous hepatopetal collaterals giving a beaded appearance. Upper gastrointestinal (GI) endoscopy showed esophageal varices. Despite endoscopic injection sclerotherapy, hematemesis occurred repeatedly there after. Following Hassab's operation, her clinical course was good, but she began passing tarry stool again in January 2001. Since the bleeding was considered due to varicosity's rupture of collaterals generated around the cholangiojejunostomy. site, an expandable metallic stent (EMS) was placed at the site of the anastomotic obstruction. One year after stent placement, blood flow in the EMS in the portal vein was good, and no GL bleeding was noted. Late complications of portal vein coresection include recurrent GI bleeding resulting from anastomotic obstruction or occlusion, as was seen in this case. Stent placement is considered nonaggressive and and effective in treating this complication.

Key words
Pylorus-preserving pancreatoduodenectomy, Expandable Metalic Stent, Portal vein stent

Reprint requests
Nobusada Koike Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666 JAPAN

Accepted
May 1, 2002

To read the PDF file you will need Abobe Reader installed on your computer.