title: Jejunal varix bleeding with extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy: report of two cases.
abstract: We present 2 patients showing afferent jejunal varix bleeding around hepaticojejunostomy caused by extrahepatic portal vein obstruction after pylorus-preserving pancreatoduodenectomy (PPPD). The case 1 was a 58-year-old woman who had recurrent anemia and hematochezia 3 years after undergoing PPPD. On the portography, the main portal vein was obliterated and collaterals around hepaticojejunostomy were developed. After percutaneous transhepatic balloon dilatation and stent placement through the obliterated portal vein, jejunal varices had disappeared and thereafter no bleeding occurred for 32 months. The case 2 was a 71-year-old man who had frequent melena 7 years after PPPD. Portal stent insertion was first tried, but failed due to severe stenosis of the main portal vein. Therefore, meso-caval shunt operation was attempted in order to reduce the variceal flow. Although an episode of a small amount of melena occurred one month after the shunt operation, there was no occurrence of bleeding for the next 8 months. For the treatment of jejunal varices, a less invasive approach, such as the angiographic intervention of stent insertion, balloon dilatation, or embolization is recommended first. Surgical operations, such as a shunt or resection of the jejunal rim, could be considered when noninvasive approaches have failed.
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Seung Duk
authors.initials: SD
authors.lastname: Lee
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Sang-Jae
authors.initials: SJ
authors.lastname: Park
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Hyun Boem
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Sung-Sik
authors.initials: SS
authors.lastname: Han
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Seong Hoon
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Tae Suk
authors.initials: TS
authors.lastname: You
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young-Kyu
authors.initials: YK
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Seong Yeon
authors.initials: SY
authors.lastname: Cho
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Soon-Ae
authors.initials: SA
authors.lastname: Lee
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Ko
authors.affiliation: Center for Liver Cancer, National Cancer Center, Goyang, Korea.
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Hong
keywords: Hepaticojejunostomy; Jejunal varices; Percutaneous transhepatic angioplasty; Portal vein stenosis; Portocaval shunt