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

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.

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

BMJ Case Reports ◽

10.1136/bcr-2018-228527 ◽

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.

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

Orvosi Hetilap ◽

10.1556/oh.2009.28607 ◽

2009 ◽

Vol 150 (26) ◽

pp. 1231-1234 ◽

Cited By ~ 1

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.

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Case Reports of Expandable Metallic Stent Treatment for Gastrointestinal Bleeding Caused by Portal Vein Stenosis after Pancreatoduodenectomy

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.75.2008 ◽

2014 ◽

Vol 75 (7) ◽

pp. 2008-2013 ◽

Cited By ~ 1

Author(s):

Masakazu WAKABAYASHI ◽

Satoru KOHNO ◽

Takeo HOKARI ◽

Kazuo AISAKI ◽

Tomohide TAKAHASHI ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Portal Vein ◽

Case Reports ◽

Metallic Stent ◽

Portal Vein Stenosis ◽

Expandable Metallic Stent ◽

Stent Treatment ◽

Vein Stenosis

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Refractory bleeding from ectopic varices stopped by percutaneous transhepatic portal vein recanalization and stenting

Case Reports in Internal Medicine ◽

10.5430/crim.v3n3p52 ◽

2016 ◽

Vol 3 (3) ◽

pp. 52

Author(s):

Guido Poggi ◽

Cesare Massa Saluzzo ◽

Benedetta Montagna ◽

Chiara Picchi ◽

Francesco Salerno

Keyword(s):

Gastrointestinal Bleeding ◽

Portal Vein ◽

Portal Vein Thrombosis ◽

Stent Placement ◽

Severe Bleeding ◽

Jejunal Varices ◽

Vein Thrombosis ◽

Ectopic Varices

Ectopic varices is an uncommon cause of gastrointestinal bleeding. We reported a case of severe bleeding due to jejunal varices which arose as a complication of extrahepatic portal vein thrombosis. The patient was successfully treated by portal vein recanalization and percutaneous transhepatic stent placement.

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Stent Placement for the Treatment of Portal Vein Stenosis or Occlusion in Pediatric Liver Transplant Recipients

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2007.06.029 ◽

2007 ◽

Vol 18 (10) ◽

pp. 1215-1221 ◽

Cited By ~ 31

Author(s):

Gi-Young Ko ◽

Kyu-Bo Sung ◽

SungGyu Lee ◽

Hyun-Ki Yoon ◽

Kyung Rae Kim ◽

...

Keyword(s):

Portal Vein ◽

Liver Transplant ◽

Stent Placement ◽

Transplant Recipients ◽

Portal Vein Stenosis ◽

Pediatric Liver ◽

Vein Stenosis ◽

Liver Transplant Recipients ◽

Pediatric Liver Transplant

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Case Report of Portal Vein Stent Placement for Portal Vein Stenosis due to Recurrence of Hilar Cholangiocarcinoma

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.74.2879 ◽

2013 ◽

Vol 74 (10) ◽

pp. 2879-2884 ◽

Cited By ~ 1

Author(s):

Yosuke OHNO ◽

Hirofumi KAMATI ◽

Yosuke TURUGA ◽

Hideki YOKO ◽

Toshiya KAMIYAMA ◽

...

Keyword(s):

Case Report ◽

Portal Vein ◽

Stent Placement ◽

Hilar Cholangiocarcinoma ◽

Portal Vein Stenosis ◽

Vein Stenosis

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Stent Placement for Portal Vein Stenosis After Pancreaticoduodenectomy

World Journal of Surgery ◽

10.1007/s00268-015-3094-5 ◽

2015 ◽

Vol 39 (9) ◽

pp. 2315-2322 ◽

Cited By ~ 4

Author(s):

Masahide Hiyoshi ◽

Yoshiro Fujii ◽

Kazuhiro Kondo ◽

Naoya Imamura ◽

Motoaki Nagano ◽

...

Keyword(s):

Portal Vein ◽

Stent Placement ◽

Portal Vein Stenosis ◽

Vein Stenosis

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Safety and Efficacy of Endovascular Treatment of Portal Vein Stenosis in Liver Transplant Recipients: A Systematic Review

Vascular and Endovascular Surgery ◽

10.1177/1538574421994417 ◽

2021 ◽

pp. 153857442199441

Author(s):

Antony Sare ◽

Vishnu Chandra ◽

Srinidhi Shanmugasundaram ◽

Pratik A. Shukla ◽

Abhishek Kumar

Keyword(s):

Portal Vein ◽

Liver Transplant ◽

Stent Placement ◽

Portal Vein Stenosis ◽

Pubmed Database ◽

Group A ◽

Pediatric Populations ◽

Group B ◽

Vein Stenosis ◽

Liver Transplant Recipients

Purpose: To evaluate the efficacy of Angioplasty and Stent Placement for the treatment of Portal Vein Stenosis in Liver Transplant Recipients by performing a systematic review. Materials and Methods: The PubMed Database was extensively searched for articles describing Portal Vein Stenosis (PVS) as a complication in Liver Transplant (LT) patients. The initial database search yielded 488 unique records published in the PubMed Database, 19 of which were deemed to meet the inclusion criteria. Outcomes were separated into 2 groups (Group A included patients with primary angioplasty, Group B included patients with primary stent placement), and further subdivided into Adult and Pediatric populations. Results: Group A included a total of 282 LT patients with portal vein stenosis. The population was predominantly pediatric (n = 243). Group B included a total of 111 LT patients with portal vein stenosis. This population was predominantly adult (n = 66). Technical success was significantly higher in both Group B pediatric (100%) and adults (97%) compared to Group A (69.5%) and (66.7%) respectively. Re-stenosis rates were significantly lower in Group B pediatric group compared to Group A (2.3% vs 29.7%, χ2 = 13.9; p < 0.001). Overall major (3.1%) and minor complications rates (1.5%) were low. Conclusion: Primary stent placement appears to have higher technical success in both populations and lower re-stenosis rates for treatment of PVS in pediatric populations.

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Jejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage

BMJ Case Reports ◽

10.1136/bcr-2018-228680 ◽

2019 ◽

Vol 12 (3) ◽

pp. e228680 ◽

Cited By ~ 1

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.

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