Korean J Radiol.  2017 Oct;18(5):828-834. 10.3348/kjr.2017.18.5.828.

Portal Vein Stenting for Delayed Jejunal Varix Bleeding Associated with Portal Venous Occlusion after Hepatobiliary and Pancreatic Surgery

Affiliations
  • 1Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea. kbjh.park@samsung.com
  • 2Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.

Abstract


OBJECTIVE
The study aimed to describe portal stenting for postoperative portal occlusion with delayed (≥ 3 months) variceal bleeding in the afferent jejunal loop.
MATERIALS AND METHODS
Eleven consecutive patients (age range, 2-79 years; eight men and three women) who underwent portal stenting between April 2009 and December 2015 were included in the study. Preoperative medical history and the postoperative clinical course were reviewed. Characteristics of portal occlusion and details of procedures were also investigated. Technical success, treatment efficacy (defined as disappearance of jejunal varix on follow-up CT), and clinical success were analyzed. Primary stent patency rate was plotted using the Kaplan-Meier method.
RESULTS
All patients underwent hepatobiliary-pancreatic cancer surgery except two children with liver transplantation for biliary atresia. Portal occlusion was caused by benign postoperative change (n = 6) and local tumor recurrence (n = 5). Variceal bleeding occurred at 27 months (4 to 72 months) and portal stenting was performed at 37 months (4 to 121 months), on average, postoperatively. Technical success, treatment efficacy, and clinical success rates were 90.9, 100, and 81.8%, respectively. The primary patency rate of portal stent was 88.9% during the mean follow-up period of 9 months. Neither procedure-related complication nor mortality occurred.
CONCLUSION
Interventional portal stenting is an effective treatment for delayed jejunal variceal bleeding due to portal occlusion after hepatobiliary-pancreatic surgery.

Keyword

Portal vein obstruction; Jejunal varix; Stent placement

MeSH Terms

Adolescent
Adult
Aged
Biliary Atresia/pathology/*surgery/therapy
Child
Child, Preschool
Female
Hemorrhage/*etiology
Humans
Jejunum/blood supply
Liver Transplantation
Male
Middle Aged
Neoplasm Recurrence, Local
Pancreatic Neoplasms/pathology/*surgery/therapy
Pancreaticoduodenectomy
Portal Vein/pathology
Postoperative Complications
Stents/*adverse effects
Tomography, X-Ray Computed
Treatment Outcome
Varicose Veins/pathology
Young Adult

Figure

  • Fig. 1 53-year-old man with hematochezia.Patient underwent pylorus-preserving pancreaticoduodenectomy due to pancreatic cancer 737 days ago.A. Axial image shows varix in afferent jejunal loop (arrow). B, C. Direct portogram (B) via transhepatic approach shows occlusion of main portal vein (arrowhead). Superior mesenteric venogram (C) demonstrates extensive collateral channels along afferent jejunal loop (arrow) and segmental occlusion of portal vein (smaller arrows). D. Direct venogram after deployment of stent (12 mm in diameter and 80 mm in length) shows disappearance of collateral channels and opacification of both portal veins. E. Follow-up CT performed 60 days after portal stenting shows patent stent and disappearance of varix in afferent jejunal loop (arrow).

  • Fig. 2 Primary patency rate of portal stent.


Cited by  1 articles

Age of Data in Contemporary Research Articles Published in Representative General Radiology Journals
Ji Hun Kang, Dong Hwan Kim, Seong Ho Park, Jung Hwan Baek
Korean J Radiol. 2018;19(6):1172-1178.    doi: 10.3348/kjr.2018.19.6.1172.


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