Successful Treatment by Expandable Metallic Stent for Gastrointestinal Bleeding from the Stenosis of the Portal Vein after Subtolal Stomach preserving Pancreatoduodenectomy: Report of a Case

Shingo Kozono, Kazuo Chijiiwa, Jiro Ohuchida, Naoya Imamura, Masahide Hiyoshi, Kazuhiro Otani, Eiji Furukoji* and Tatefumi Sakae*

Department of Surgical Oncology and Regulation of Organ Function and Department of Radiology*, Miyazaki University School of Medicine

We report the successful treatment with a portal vein stent for melena caused by varices developing around a hepaticojejunostomy after pancreaticoduodenectomy. A 49-year-old man undergoing subtotal stomach-preserving pancreaticoduodenectomy in June 2003 followed by postoperative chemoradiation therapy for pancreas head cancer had an uneventful clinical course until he reported melena and abdominal pain in 2005. Diagnosed with diverticular hemorrhage of the ascending colon, he underwent right hemicolectomy, but melena persisted and he was readmitted in October 2005. Angiography and abdominal contrast-enhanced computed tomography (CT) showed stenosis of the extrahepatic portal vein and the collateral vein with varices around the hepaticojejunostomy. Double-balloon enteroscopy showed varices and an ulcer close to the hepaticojejunostomy. Varices caused by portal vein stenosis and apparently causing intestinal bleeding were treated by placing an expandable metallic stent in the stenotic portal vein through a percutaneous transhepatic route. After treatment, the collateral vein disappeared and intestinal bleeding ceased. The man is now doing well 3 years after portal vein stent and over 5 years after pancreaticoduodenectomy.

Key words
portal vein stent, pancreaticoduodenectomy, gastrointestinal bleeding

Reprint requests
Kazuo Chijiiwa Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine
5200 Kihara, Kiyotake, Miyazaki, 889-1682 JAPAN

Accepted
March 25, 2009

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