title: Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy.
abstract: Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Ikuo
authors.initials: I
authors.lastname: Watanobe
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Ito
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Akimoto
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Sekine
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Yurie
authors.initials: Y
authors.lastname: Haruyama
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Kota
authors.initials: K
authors.lastname: Amemiya
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Miyano
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Taijiro
authors.initials: T
authors.lastname: Kosaka
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Michio
authors.initials: M
authors.lastname: Machida
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kitabatake
authors.affiliation: Department of General Surgery, Juntendo University Nerima Hospital, Tokyo, Japan.
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Kojima
keywords: Late-onset hemorrhage; Pancreaticoduodenectomy; Portal vein thrombosis; Postoperative hemorrhage; Postoperative pancreatic fistula