Treatment of bleeding from a portion of pancreatojejunostomy after pancreaticoduodenectomy with division of the splenic vein : two case reports

Kushiya Hiroki; Noji Takehiro; Abo Daisuke; Soyama Takeshi; Tanaka Kimitaka; Nakanishi Yoshitsugu; Asano Toshimichi; Nakamura Toru; Tsuchikawa Takahiro; Okamura Keisuke; Hirano Satoshi

Title	en Treatment of bleeding from a portion of pancreatojejunostomy after pancreaticoduodenectomy with division of the splenic vein : two case reports
Creator	en Kushiya, Hiroki en Noji, Takehiro NRID 1000010739296 en Abo, Daisuke NRID 1000030399844 en Soyama, Takeshi NRID 1000000794059 en Tanaka, Kimitaka NRID 1000010758642 en Nakanishi, Yoshitsugu NRID 1000040447058 en Asano, Toshimichi NRID 1000010756688 en Nakamura, Toru NRID 1000070645796 en Tsuchikawa, Takahiro NRID 1000050507572 en Okamura, Keisuke NRID 1000090724401 en Hirano, Satoshi NRID 1000050322813
Accessrights	metadata only access
Rights	https://creativecommons.org/licenses/by/4.0/ en Creative Commons Attribution 4.0 International
Subject	Other en Pancreaticoduodenectomy Other en Left-sided portal hypertension Other en Interventional radiology Other en Intestinal bleeding NDC 490
Description	Abstract en Background There is no definitive strategy for gastrointestinal bleeding due to left-sided portal hypertension after pancreaticoduodenectomy (PD) for pancreatic cancer (PC) with concomitant portal vein resection (PVR). Case presentation Case 1: A 70-year-old woman underwent a PD for PC with PVR. Seven years after her surgery, she suffered severe anemia with suspected gastrointestinal bleeding. Computed tomography scan (CT) revealed varices at a portion of the pancreaticojejunostomy (PJ). Angiography revealed that splenic venous flow drained into the varices and then into the portal vein. A diagnosis of bleeding varices of the PJ due to left-sided portal hypertension was made. Following a partial splenic artery embolization, her anemia improved. Case 2: An 80-year-old male underwent a PD for pancreatic head cancer combined with resection of the confluence of the portal and splenic veins with a reconstruction between the portal and superior mesenteric veins. Eighteen months after his surgery, he developed melena with negative endoscopy findings in his large and small bowel. CT revealed varices at the site of the PJ that communicated with the jejunal and portal veins. He underwent obliteration of the varices via a trans-portal-venous approach. As a result, he remained without melena until he died of PC 17 months after the embolization. Conclusions Left-sided portal hypertension following a PD with bleeding varices can be treated by interventional radiology with minimal invasiveness.
Publisher	en Springer (SpringerOpen)
Date	Issued2019-08-08
Language	eng
Resource Type	journal article
Version Type	NA
Identifier	HDL http://hdl.handle.net/2115/75509
Relation	isIdenticalTo DOI https://doi.org/10.1186/s40792-019-0687-5 PMID 31396775
Journal	PISSN 2198-7793 en Surgical case reports Volume Number5 Issue Number1 Page Start128
Oaidate	2023-07-26