Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy

Abstract

Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.

Intrahepatic portal vein thrombosis due to postoperative biliary obstruction successfully treated by a partial thrombectomy combined with thrombolytic drug therapy

“…The cause and mechanism of PVT after PD in the present patient could not be defined, but PV reconstruction can result in PVT by transient occlusion [3] , [4] , [5] . However, Doppler ultrasonography confirmed intrahepatic portal flow.…”

“…Portal flow during combined vascular resection can become transiently blocked within 30 min of vascular reconstruction. A 30-min block without a portal bypass is probably safe, but postoperative portal vein thrombosis (PVT) can arise after invasive procedures as hepatectomy or pancreaticoduodenectomy (PD) [3] , [4] , [5] . The mechanism of PVT might involve various factors such as the intraoperative occlusion of portal flow, a kinked portal trunk, stenosis of a vascular anastomosis and surrounding inflammation [3] , [4] , [5] , [6] , [7] , [8] .…”

Stent placement for benign portal vein stenosis following pancreaticoduodenectomy in a hybrid operating room

“…Benign portal vein (PV) stenosis is a rare complication following hepato-biliary-pancreatic surgery, such as hepatectomy and pancreaticoduodenectomy (PD) (1,2). The most frequent cause of stenosis is postoperative inflammation, which leads to portal hypertension and subsequent gastrointestinal hemorrhage from varices (3).…”