Portal vein stenting to treat portal vein stenosis in a patient with malignant tumor and gastrointestinal bleeding.
This report describes the successful use of portal venous stent placement for a patient with recurrent melena secondary to jejunal varices that developed after subtotal stomach preserved pancreatoduodenectomy (SSPPD). A 67-year-old man was admitted to our hospital with tarry stool and severe anemia at 2 years after SSPPD for carcinoma of the head of the pancreas. Abdominal computed tomography examination showed severe stenosis of the extrahepatic portal vein caused by local recurrence and showed an intensely enhanced jejunal wall at the choledochojejunostomy. Gastrointestinal bleeding scintigraphy also revealed active bleeding near the choledochojejunostomy. Based on these findings, jejunal varices resulting from portal vein stenosis were suspected as the cause of the melena. Portal vein stenting and balloon dilation was performed via the ileocecal vein after laparotomy. Coiling of the jejunal varices and sclerotherapy of the dilate postgastric vein with 5% ethanolamine oleate with iopamidol was performed. After portal stent placement, the patient was able to lead a normal life without gastrointestinal hemorrhage. However, he died 7 months later due to liver metastasis.
1 Department of Surgical Oncology and 2Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan.
Katsunobu
K
Sakurai
Ryosuke
R
Amano
Akira
A
Yamamoto
Norifumi
N
Nishida
Shinya
S
Matsutani
Keiichiro
K
Hirata
Kenjiro
K
Kimura
Kazuya
K
Muguruma
Takahiro
T
Toyokawa
Naoshi
N
Kubo
Hiroaki
H
Tanaka
Masakazu
M
Yashiro
Masaichi
M
Ohira
Kosei
K
Hirakawa
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003251:Constriction, Pathologic / Q000209:etiology / Q000628:therapy; D017809:Fatal Outcome; D006801:Humans; D007583:Jejunum / Q000098:blood supply; D008297:Male; D008551:Melena / Q000209:etiology; D009364:Neoplasm Recurrence, Local / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011169:Portal Vein / Q000473:pathology*; D011183:Postoperative Complications / Q000628:therapy*; D015607:Stents; D014648:Varicose Veins / Q000209:etiology