Portal Vein Stenting for Portal Vein Stenosis After Pancreatoduodenectomy: A Case Report

Abstract

Portal vein stenosis, which results in serious clinical conditions such as gastrointestinal variceal bleeding and liver failure, is caused by hepatobiliary pancreatic cancer or major postoperative complications after hepatobiliary pancreatic surgery. In recent years, portal vein stenting under interventional radiology has been applied as a more useful treatment method for portal vein stenosis than invasive surgery. We herein report the successful use of a vascular stent for portal vein stenosis after pancreatoduodenectomy. A 66-year-old man with distal cholangiocarcinoma underwent subtotal stomach-preserving pancreatoduodenectomy with resection of the portal vein because of direct invasion to the main portal vein at our hospital. The portal vein was reconstructed without a venous graft. He developed jejunal bleeding near the pancreatojejunostomy on postoperative day (POD) 2. Although embolization of the responsible vessel achieved hemostasis, an intraoperatively inserted drainage tube was needed for a long period of time postoperatively because the embolized afferent jejunum was perforated. He was discharged on POD 39 after removal of the drainage tube. On POD 282, he was readmitted with melena and severe fatigue. Computed tomography revealed an obstruction of the reconstructed portal vein and varices at the hepaticojejunostomy site. We diagnosed variceal bleeding and performed percutaneous transhepatic stenting in the obstructed portal vein. The patient was discharged in good clinical condition on day 15 after stenting. In conclusion, portal vein stenting is a useful and less invasive therapy for portal vein stenosis.

An Elbow Patch Reconstruction Technique for Narrowed Remnant Portal Veins during Right Lobe Living Donor Hepatectomy: A Rescue Surgery

“…Another option is the use of tubularized autologous peritoneal patch, as described by Sabuncuoglu and colleagues [42]. For cases of narrowing discovered after surgery, the role of stent placement has been discussed [27][28][29]. The approach for stent placement can be percutaneous transhepatic or through the ileocolic vein.…”

“…However, this may be associated with restenosis, especially at the anastomotic site, which will subsequently cause portal hypertension and its sequelae. The role of postoperative portal venous stent placement has also been discussed [27][28][29]. The approach for stent placement can be transhepatic, percutaneous, or through the ileocolic vein.…”

“…The approach for stent placement can be transhepatic, percutaneous, or through the ileocolic vein. The use of stents has been associated with some complications like stent migration, thrombosis, sepsis, and occlusion [27][28][29]. In cases diagnosed after the operation, a stent can be placed in the narrow segment of the portal vein by interventional radiologists [30].…”

“…We aimed to present a new approach, termed the "elbow patch reconstruction technique", to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. stents has been associated with some complications like stent migration, thrombosis, sepsis, and occlusion [27][28][29]. In cases diagnosed after the operation, a stent can be placed in the narrow segment of the portal vein by interventional radiologists [30].…”

Hepatectomy with simultaneous resection of portal vein for Bismuth IV perihilar cholangiocarcinoma: a case report

“…Once postoperative gastrointestinal bleeding caused by portal vein stenosis is found, stenosis should be treated and portal vein stents should be placed, if necessary [17]. As a result of the multiple risk factors associated with cholangiocarcinoma, postoperative chemotherapy for cholangiocarcinoma has become a routine treatment.…”