Novel bile duct repair for bleeding biliary anastomotic varices: case report and literature review.
An unusual case of variceal bleeding at the site of a biliary enteric anastomosis is presented. This entity can occur when a high-to-low pressure gradient forms in a variceal field. In this case the anastomotic site was the location of the pressure gradient from the high-pressure small bowel varices to the low-pressure biliary tract. This was successfully treated by disconnection of the anastomosis. The resulting biliary defect was patched with small intestinal submucosa, which functioned successfully as a scaffold for biliary epithelial ingrowth.
Smith
Andrew M
AM
Department of General Surgery, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Walsh
R Matthew
RM
Henderson
J Michael
JM
D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000792:Angiography; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002779:Cholestasis / Q000209:etiology / Q000628:therapy; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007583:Jejunum / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D015607:Stents; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014648:Varicose Veins / Q000209:etiology / Q000601:surgery