scholarly journals Jejunal varices as a rare cause of recurrent gastrointestinal bleeding in a 74-year-old man with extrahepatic portal hypertension after pancreato-biliary surgery

2019 ◽  
Vol 12 (3) ◽  
pp. e228527
Author(s):  
Philipp Kasper ◽  
Christoph Schramm ◽  
Natalie Jaspers ◽  
Tobias Goeser
Keyword(s):  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Portal Pressure ◽  
Biliary Surgery ◽  
Jejunal Varices ◽  
Portal Vein Stenosis ◽  
History Of ◽  
Endovascular Stent Placement ◽  
Diagnostic Work ◽  
Vein Stenosis

A 74-year-old man presented to our hospital with recurrent lower gastrointestinal bleeding. His past medical history was remarkable for a duodenal papilla carcinoma and he underwent a pylorus-preserving pancreaticoduodenectomy 4 years before. During diagnostic work-up a severe portal vein stenosis after surgery and multiple dilated intramural jejunal varices, which formed as collateral pathways could be detected. Based on these findings, the recurrent haemorrhages were considered to be due to repeated rupturing and bleeding of jejunal varices. Therapeutically, the portal vein stenosis was treated with endovascular stent placement leading to a reduction in prestenotic portal pressure. During follow-up no further episodes of gastrointestinal bleeding were observed. Bleeding from jejunal varices is a very rare cause of gastrointestinal haemorrhages and represents a diagnostic and therapeutic challenge. However, it should be considered in differential diagnosis of obscure recurrent gastrointestinal haemorrhages in patients with a history of hepato-pancreato-biliary surgery.

scholarly journals Portal Vein Stenting to Treat Portal Vein Stenosis in a Patient With Malignant Tumor and Gastrointestinal Bleeding

2014 ◽  
Vol 99 (1) ◽  
pp. 91-95 ◽  
Author(s):  
Katsunobu Sakurai ◽  
Ryosuke Amano ◽  
Akira Yamamoto ◽  
Norifumi Nishida ◽  
Shinya Matsutani ◽  
...  
Keyword(s):  
Gastrointestinal Bleeding ◽  
Portal Vein ◽  
Stent Placement ◽  
Balloon Dilation ◽  
Severe Stenosis ◽  
Jejunal Varices ◽  
Portal Vein Stenosis ◽  
Head Of The Pancreas ◽  
Vein Stenosis ◽  
Jejunal Wall

Abstract This report describes the successful use of portal venous stent placement for a patient with recurrent melena secondary to jejunal varices that developed after subtotal stomach preserved pancreatoduodenectomy (SSPPD). A 67-year-old man was admitted to our hospital with tarry stool and severe anemia at 2 years after SSPPD for carcinoma of the head of the pancreas. Abdominal computed tomography examination showed severe stenosis of the extrahepatic portal vein caused by local recurrence and showed an intensely enhanced jejunal wall at the choledochojejunostomy. Gastrointestinal bleeding scintigraphy also revealed active bleeding near the choledochojejunostomy. Based on these findings, jejunal varices resulting from portal vein stenosis were suspected as the cause of the melena. Portal vein stenting and balloon dilation was performed via the ileocecal vein after laparotomy. Coiling of the jejunal varices and sclerotherapy of the dilate postgastric vein with 5% ethanolamine oleate with iopamidol was performed. After portal stent placement, the patient was able to lead a normal life without gastrointestinal hemorrhage. However, he died 7 months later due to liver metastasis.

Effect of Long-Term Octreotide and Isosorbide Dinitrate on Haemodynamics in Rats with Portal Vein Stenosis

1998 ◽  
Vol 94 (6) ◽  
pp. 645-650 ◽  
Author(s):  
Han-Chieh Lin ◽  
Yi-Tsau Huang ◽  
Yuh-Ren Cheng ◽  
Ming-Chih Hou ◽  
Fa-Yauh Lee ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Isosorbide Dinitrate ◽  
Portal Pressure ◽  
Vehicle Group ◽  
Hyperdynamic Circulation ◽  
Portal Vein Stenosis ◽  
Term Administration ◽  
Vein Stenosis

1. Both octreotide and isosorbide dinitrate have been shown to have portal hypotensive effects in animals with portal hypertension. Moreover, in both animals and humans with portal hypertension, the reduction of portal pressure was enhanced when nitrovasodilators were combined with propranolol or vasopressin. The present study was undertaken to evaluate the effect of long-term administration of octreotide and isosorbide dinitrate on haemodynamics in rats with portal vein stenosis. 2. Portal hypertension was induced by portal vein stenosis. Portal hypertensive rats were allocated into one of four groups (eight rats in each group): vehicle group, octreotide group (100 μg/kg via subcutaneous injection every 12 h), isosorbide dinitrate group (5 mg/kg via gastric gavage every 12 h) and combined treatment group. Drug was given for eight consecutive days, starting 1 day before surgery. Haemodynamic values were measured using a radioactive microsphere technique. 3. Long-term octreotide treatment decreased portal pressure and improved the hyperdynamic circulation. In contrast, long-term administration of isosorbide dinitrate reduced portal pressure but did not ameliorate vasodilatation. A combination of octreotide and isosorbide dinitrate improved the hyperdynamic circulation with a reduction of portal pressure. In addition, the mean value of portal pressure after combination treatment was significantly lower than in rats receiving octreotide alone. 4. These results showed that, in rats with portal hypertension, long-term combined administration of octreotide and isosorbide dinitrate improved the hyperdynamic circulation together with a more profound reduction of portal pressure than rats receiving octreotide alone.

scholarly journals Jejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage

2019 ◽  
Vol 12 (3) ◽  
pp. e228680 ◽  
Author(s):  
Caleb Joseph Heiberger ◽  
Tej Ishaan Mehta ◽  
Douglas Yim
Keyword(s):  
Portal Vein ◽  
Gastrointestinal Haemorrhage ◽  
Severe Anaemia ◽  
Jejunal Varices ◽  
Portal Vein Stenosis ◽  
Endoscopic Clips ◽  
Rapid Decompression ◽  
Adenocarcinoma Of The Pancreas ◽  
Vein Stenosis ◽  
And Control

A 78-year-old woman presented with melaenic stool and severe anaemia 4 years after a pancreaticoduodenectomy for adenocarcinoma of the pancreas. Initial workup revealed haemorrhage from the choledochojejunostomy site. Despite multiple endoscopic clips to the region, bleeding reoccurred multiple times over a period of several months. Due to ongoing haemorrhage, her case was urgently presented at the hospital’s multidisciplinary hepatobiliary conference. The contrast-enhanced abdominal CT revealed severe stenosis of the extrahepatic portal vein and large afferent jejunal varices at the choledochojejunostomy, suspected as the cause of her persistent bleed. The recommendation was a percutaneous transhepatic approach for stenting of the portal vein stenosis that resulted in rapid decompression of the jejunal varices and control of her haemorrhage.

Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

2020 ◽  
Vol 13 (12) ◽  
pp. e235986
Author(s):  
Alexander Tindale ◽  
James Jackson ◽  
Darina Kohoutova ◽  
Panagiotis Vlavianos
Keyword(s):  
Portal Vein ◽  
Complete Resolution ◽  
Chylous Ascites ◽  
Biliary Pancreatitis ◽  
Acute Biliary Pancreatitis ◽  
Portal Vein Stenosis ◽  
First Case ◽  
Vein Stenosis ◽  
Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

scholarly journals Percutaneous transhepatic metallic stent placement for the treatment of post-transplantation portal vein stenosis

2009 ◽  
Vol 150 (26) ◽  
pp. 1231-1234 ◽  
Author(s):  
Attila Doros ◽  
Balázs Nemes ◽  
Imre Fehérvári ◽  
Dénes Görög ◽  
Zsuzsa Gerlei ◽  
...  
Keyword(s):  
Portal Vein ◽  
Stent Placement ◽  
Metallic Stent ◽  
Post Transplantation ◽  
Portal Vein Stenosis ◽  
Vein Stenosis ◽  
Metallic Stent Placement

A májátültetés rutinszerűen, jó eredménnyel alkalmazott eljárás a végstádiumú májelégtelenség kezelésében. A transzplantáció után kialakuló éreredetű szövődmények közül a legritkább a májkapuér-szűkület. Ennek intervenciós radiológiai megoldását mutatjuk be három eset kapcsán. Célkitűzés: A portalis véna szűkületének sebészi kezelése kockázatos, különösen a korai poszttranszplantációs időszakban. Az intervenciós radiológiai beavatkozások általában kis megterheléssel, kevés szövődménnyel alkalmazhatók. Célunk bemutatni a percutan transhepaticus fémstentbehelyezés biztonságosságát, eredményességét. Módszer: Háromszázkilencvenhat májátültetés után összesen három esetben (0,07%) észleltük az anasztomózis korai beszűkülését. Ezekben az esetekben ultrahangvezérelt percutan transhepaticus venaportae-punkciót végeztünk vékony tűvel, majd koaxiális tágítókatétert alkalmazva stent behelyezésére alkalmas introducert vezettünk át a májszöveten. A szűk anasztomózisba nitinol (2 esetben), illetve acél (1 esetben) öntáguló fémstentet helyeztünk. Az introducer eltávolítása közben a parenchymás járatot egy alkalommal embolizációs spirállal, egyszer pedig sebészi szivacsrészecskékkel embolizáltuk. A harmadik esetben embolizáció nem történt. Eredmények: A kezelés mindhárom esetben sikeres volt. A beavatkozással kapcsolatban szövődményt nem észleltünk. Két esetben az indikációt jelentő hasi folyadék mennyiségének csökkenése, egy esetben a nyelőcső-varicositas visszafejlődése jelentette a klinikai kép javulását. Mindhárom esetben ultrahangos és komputeres rétegvizsgálat is igazolta a szűkületek sikeres kezelését. Két beteg a beavatkozás után 10, illetve 39 hónappal jól van. Egy beteget a beavatkozás után egy hónappal többszervi elégtelenség miatt elvesztettünk. Következtetés: A venaportae-anasztomózis szűkületeinek kezelésére a percutan transhepaticus kanülálás és öntáguló fémstent behelyezése biztonságosan és sikeresen alkalmazható.

scholarly journals Correction of extrahepatic portal hypertension in pediatric patient after liver transplantation

2017 ◽  
Vol 19 (1) ◽  
pp. 47-51
Author(s):  
A. R. Monakhov ◽  
B. L. Mironkov ◽  
T. A. Dzhanbekov ◽  
K. O. Semash ◽  
Kh. M. Khizroev ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Blood Flow ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Pediatric Patient ◽  
Portal Blood Flow ◽  
Portal Blood ◽  
Positive Trend ◽  
Portal Vein Stenosis ◽  
Vein Stenosis

Introduction. Liver transplantation is a multi-component and complex type of operative treatment. Patients undergoing such a treatment sometimes are getting various complications. One of these complications is a portal hypertension associated with portal vein stenosis.Materials and methods. In 6 years after the left lateral section transplantation from living donor in a pediatric patient the signs of portal hypertension were observed. Stenosis of the portal vein was revealed. Due to this fact percutaneous transhepatic correction of portal vein stenosis was performed.Results. As a result of the correction of portal blood flow in the patient a positive trend was noted. According to the laboratory and instrumental methods of examination the graft had a normal function, portal blood flow was adequate. In order to control the stent patency Doppler ultrasound and MSCT of the abdominal cavity with intravenous bolus contrasting were performed. Due to these examinations the stent function was good, the rate of blood flow in the portal vein due to Doppler data has reached 80 cm/sec, and a decrease of the spleen size was noted.Conclusion. Diagnosis and timely detection of portal vein stenosis in patients after liver transplantation are very important for the preservation of graft function and for the prevention of portal hypertension. In order to do that, ultrasound Doppler fluorimetry examination needs to be performed to each patient after liver transplantation. In cases of violation of the blood flow in the portal vein CT angiography performance is needed. Percutaneous transhepatic stenting of portal vein is a minimally invasive and highly effective method of correction of portal hypertension. Antiplatelet therapy and platelet aggregation control are the prerequisites for successful stent function.

scholarly journals Portal vein stenosis in children with segmental liver transplants: treatment with percutaneous transhepatic venoplasty.

1995 ◽  
Vol 165 (1) ◽  
pp. 161-165 ◽  
Author(s):  
B Funaki ◽  
J D Rosenblum ◽  
J A Leef ◽  
C A Hackworth ◽  
G X Szymski ◽  
...  
Keyword(s):  
Portal Vein ◽  
Liver Transplants ◽  
Portal Vein Stenosis ◽  
Vein Stenosis
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