title: Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma.
abstract: BACKGROUND
  A fistula between the duodenum and the main portal vein near a peptic ulcer is extremely rare, and only two cases of duodenal ulcers have been reported in the past.
  
  
  METHODS
  We report a 68-year-old man with a diagnosis of anemia who had a history of extended right hepatectomy for hilar cholangiocarcinoma 20 months previously. The first endoscopic examination revealed a giant peptic ulcer with active bleeding at the posterior wall of the duodenal bulbs, and hemostasis was performed. Endoscopic treatment and transarterial embolization were performed repeatedly because of uncontrollable bleeding from the duodenal ulcer. Nevertheless, he died of sudden massive hematemesis on the 20th hospital day. At autopsy, communication with the main portal vein and duodenal ulcer was observed.
  
  
  CONCLUSIONS
  It should be borne in mind that the main portal vein is exposed at the front of the hepatoduodenal ligament in cases with previous extrahepatic bile duct resection.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan. hry-kinoshita@wakayamah.rofuku.go.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Katsunari
authors.initials: K
authors.lastname: Takifuji
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakatani
authors.forename: Masaji
authors.initials: M
authors.lastname: Tani
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Uchiyama
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue