Effective Portal Stent Placement Using "Kissing" Technique by Transileocolic Approach for Jejunal Variceal Bleeding in Afferent Loop Caused by Local Recurrence of Hilar Cholangiocarcinoma: A Case Report

Abstract

Malignant portal vein stenosis or occlusion can lead to portal hypertension with complications such as intestinal variceal bleeding. We report herein a patient successfully treated by transileocolic portal venous stent placement using kissing technique for malignant portal vein obstruction with associated small bowel varices. The case had liver dysfunction and anemia caused by melena. Portography showed severe stenosis of the bilateral first branches of the portal vein from recurrent hilar cholangiocarcinoma and dilated jejunal veins supplying varices as the suspected cause of intestinal bleeding. Double self-expandable metallic stents were placed in bilateral branches of the portal vein across a main portal vein using the "kissing" technique by transileocolic approach. Portography after stent placement showed relief of the portal vein stenosis and disappearance of the jejunal venous collaterals. Liver dysfunction and symptoms were improved after the procedure. Kissing stenting via an transileocolic approach is an effective option for malignant obstruction of bilateral portal vein branches.