Abstract
The patient was a 63-year-old woman who underwent a pancreatoduodenectomy with reconstruction with the modified Child's method for bile duct cancer in August 2007. She was admitted for melena in September 2008. Laboratory examination showed a hemoglobin level of 6.7g/dL. Abdominal enhanced CT showed severe portal vein stenosis, the mass being located behind the superior mesenteric vein and the portal vein, and a strongly stained bile duct. From these findings, the patient was diagnosed as having recurrence of bile duct cancer, and hepatopetal collaterals resulting from portal hypertension was suspected as the cause of the melena. Gastrointestinal endoscopy revealed small amounts of clotting blood in the jejunum. Through further examination of the jejunum, a small exposed vessel with oozing was detected in the choledochojejunostomy. Since the melena was considered as hemorrhage from choledochojejunostomy varices fed by hepatopetal collaterals, an expandable metallic stent was placed at the portal vein stenotic lesion. Portography after stent placement revealed the disappearance of the collaterals. After the treatment, the patient underwent chemotherapy, and no further episodes of gastrointestinal hemorrhage have occurred.
