Jejunal Varix Bleeding after Pancreaticoduodenectomy Successfully Treated with Portal Vein Stent Placement and Endoscopic Sclerotherapy

Na, Hyun Jin; Kang, Won Sik; Choi, Ja Sung; Kang, Beo Deul; Cho, Jae Hee; Park, Kyung Won; Kim, Hyun Boem; Kim, Hee Man

doi:2013.18.3.37

Korean J Pancreas Biliary Tract > Volume 18(3):2013 > Article

Case Reports

The Korean Journal of Pancreas and Biliary Tract 2013;18(3):37-40. doi: https://doi.org/10.15279/kpba.2013.18.3.37

휘플씨 수술후 발생한 공장 정맥류 출혈을 문맥 스텐트 및 내시경 경화술로 치료한 1예

나현진¹, 강원식¹, 최자성¹, 강버들¹, 조재희^1,2, 박경원¹, 김현범³, 김희만^1,2

¹명지병원 소화기내과, ²관동대학교 의과대학 내과학교실, ³국립암센터 영상의학교실"

Jejunal Varix Bleeding after Pancreaticoduodenectomy Successfully Treated with Portal Vein Stent Placement and Endoscopic Sclerotherapy

Hyun Jin Na¹, Won Sik Kang¹, Ja Sung Choi¹, Beo Deul Kang¹, Jae Hee Cho^1,2, Kyung Won Park¹, Hyun Boem Kim³, Hee Man Kim^1,2

¹Division of Gastroenterology, Department of Internal Medicine, Myongji Hospital, Goyang, Korea, ²Department of Internal Medicine, Kwandong University College of Medicine, Gangneung, Korea ³Department of Radiology, National Cancer Center, Goyang, Korea

ABSTRACT

A 57-year-old woman, who had undergone pancreaticoduodenectomy and chemo-radiation therapy for common bile duct cancer 7 years ago, visited our institution for hematochezia. Esophagogastroduodenoscopy and colonoscopy couldn't detect bleeding focus and abdomen computed tomography showed stenosis of portal vein and jejunal varices. Subsequent to percutaneous transhepatic portography, we dilated the extrahepatic portal vein using a balloon catheter and placed a stent. The patient had hematochezia after two weeks again. EGD was performed and a new stigmata was found at the afferent loop of small bowel. We injected histoacryl and no more bleeding was occurred. For the treatment of jejunal varices, a less invasive approach, such as portal stent placement and endoscopic sclerotherapy can be a useful tool, especially after abdominal surgery.

Keywords: jejunal varices, portal vein stenosis, sclerotherapy, pancreaticoduodenectomy