A case of hepatic artery embolization and partial arterialization of the portal vein for intraperitoneal, hemorrhage after a pancreaticoduodenectomy.
We report a case of hepatic artery embolization and partial portal vein arterialization for the treatment of a delayed massive hemorrhage after a pancreaticoduodenectomy. A 70-year-old male underwent a pancreaticoduodenectomy for the treatment of lower bile duct cancer. A slight discharge of pancreatic juice was recognized early during the postoperative period. A delayed massive hemorrhage occurred on postoperative day 34, resulting in hypotensive shock. Angiography and computed tomography examinations revealed bleeding from a pseudoaneurysm at the stump of the gastroduodenal artery and portal vein compression by the hematoma. Embolization of the stump of the gastroduodenal artery resulted in the total occlusion of the hepatic artery. We performed a partial portal vein arterialization via side-to-side anastomosis of a branch of the ileal artery and vein. The partial portal oxygen pressure increased from 70 mmHg to 90 mmHg. A liver abscess was recognized two weeks after the arterialization, but was successfully treated by percutaneous transhepatic drainage. The patient was discharged from hospital in good condition on postoperative day 69. Whether the partial portal vein arterialization was effective is unclear, but partial portal vein arterialization should be considered as an option in cases of total hepatic artery occlusion with impairment of portal blood flow.
Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, Japan. teraken.srg1@med.tmd.ac.jp
Kenichi
K
Teramoto
Tohru
T
Kawamura
Susumu
S
Takamatsu
Norio
N
Noguchi
Shigeki
S
Arii
D000368:Aged; D017541:Aneurysm, False / Q000628:therapy; D001650:Bile Duct Neoplasms / Q000601:surgery*; D004621:Embolization, Therapeutic; D006499:Hepatic Artery; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D010532:Peritoneal Diseases / Q000209:etiology / Q000628:therapy*; D011169:Portal Vein; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy*