Modified interventional obliteration for variceal hemorrhage from elevated jejunum after pylorus-preserving pancreatoduodenectomy.
Ectopic variceal hemorrhage caused by sinistral portal hypertension after splenic vein ligation during a pyloric-preserving pancreatoduodenectomy is a rare entity. We report the case of a 58-year-old man with symptoms of refractory melena. The varices could not be treated endoscopically and surgery was considered unsuitable due to severe adhesions and altered anatomy. Following clinical failure of partial splenic embolization, an alternative obliteration method by a retrograde trans-portal-venous approach was successfully performed and resolved the problem. It seems to be an effective method for ectopic variceal bleeding, especially when other interventions are unavailable or highly risky.
Department of Radiology, Center for Endovascular Therapy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuou-ku, Kobe, Hyogo, 650-0057, Japan, nosakamoto@hotmail.co.jp.
Noriaki
N
Sakamoto
Masato
M
Yamaguchi
Keitaro
K
Sofue
Akhmadu
A
Muradi
Koji
K
Idoguchi
Takuya
T
Okada
Eisuke
E
Ueshima
Koji
K
Sugimoto
D015901:Angiography, Digital Subtraction / Q000379:methods; D021721:Balloon Occlusion / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007583:Jejunum / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014463:Ultrasonography