A Case of Small Intestinal Bleeding Caused by a Internal Stent for Pancreatic Duct

Abstract

A 75–year–old man underwent subtotal stomach–preserving pancreatoduodenectomy for lower bile duct carcinoma, and subsequently, pancreatojejunostomy was performed by the modified Blumgart method using a 7.5–Fr pancreatic duct tube as a internal stent. Since blood was drawn on the 5th, 7th, and 9th days after the surgery, endoscopy was performed each time. However, in consideration of the burden on the pancreatojejunostomy, observations of the anastomotic part were avoided. No lesion that could cause massive hemorrhage was detected, but a hematoma was found in the region of the Braun anastomosis, which was suspected as the bleeding site; therefore, the Braun anastomosis was clipped under the endoscope on the 7th day after surgery and the same site was opened and re–anastomosis was performed on the 9th day after surgery. On the 11th day after surgery, bleeding occurred again, and contrast–enhanced CT revealed a large hematoma extending from the pancreatojejunostomy to the Braun anastomosis, and bleeding near the pancreatojejunostomy was suspected. Because arterial hemorrhage from the jejunal mucosa opposite the pancreatojejunostomy was confirmed by endoscopic observation, hemostasis was accomplished with clips. The bleeding was considered as having been due to physical stimulation by the internal stent. The patient was discharged on the 35th day after the first operation without any further bleeding episodes.