title: Unusual bleeding from hepaticojejunostomy controlled by adult variable stiffness colonoscopy: report of a case and literature review.
abstract: We herein present a case of a 59-year-old man who had undergone pylorus preserving pancreaticoduodenectomy with regional lymph node dissection prior to episodes of melena. Series of conventional endoscopic investigations failed to identify the bleeding source. Enhanced computed tomography scan revealed complete obstruction of the main portal vein with numerous collateral veins running towards the hepatic hilus. Comprehensively, hemorrhage from the jejunal varices caused by postoperative portal hypertension was highly suspected. As the jejunal loop was out of reach, adult variable-stiffness colonoscope (AVSC) was utilized to solve the Roux-en-Y anatomy. Numerous telangiectasis and small varices at hepaticojejunostomy were observed and in the mean time, bleeding was noticed and endoclips were placed without any delay. Ectopic variceal bleeding in jejunal loop after pancreaticoduodenectomy is difficult to manage. We believe that AVSC is an alternative device when specialized jejunal endoscopy is not available.
authors.affiliation: 1 Saitama Medical Center, Saitama Medical University, Saitama, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Baba
authors.forename: Mai
authors.initials: M
authors.lastname: Wakabayashi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Oba
authors.forename: Hironobu
authors.initials: H
authors.lastname: Baba
authors.forename: Akito
authors.initials: A
authors.lastname: Mitsuoka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nakamura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sanada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kuwabara
authors.forename: Kazumi
authors.initials: K
authors.lastname: Nakajima
authors.forename: Narihide
authors.initials: N
authors.lastname: Goseki
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ishida
mesh_terms: D000713:Anastomosis, Roux-en-Y; D003113:Colonoscopy / Q000379:methods*; D013505:Digestive System Surgical Procedures; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000628:therapy
keywords: Adult variable stiffness colonoscopy; Endoclip; Hepaticojejunostomy; Jejunal varicose vein; Portal hypertension