Abstract
A 74-year-old man who had undergone pancreatoduodenectomy for carcinoma of the papilla of Vater in August 2010 was admitted to the emergency room due to consciousness disorder in December 2010. Hepatic encephalopathy was ascertained, which resulted from hepatic failure resulting from the extrahepatic portal vein obstruction owing to postoperative pancreatic fistula. Because of lack of response to conservative management, portal venous stenting was tried two months later. At first, transileocolic portal venous stenting was chosen because the intrahepatic portal venous flow could not be comfirmed. When the first stenting failed, stringlike stenotic intrahepatic and extrahepatic portal veins with slow blood flow was observed, which suggested the probability of cannulization of the portal vein. Finally, stenting under portography and dilation of the portal vein obstruction were achieved via a percutaneous transhepatic route. Portal blood flow was improved, and subsequently, liver failure disappeared. In this article, we report effective transhepatic portal venous stent placement as one treatment option for benign extrahepatic portal venous obstruction after pancreatoduodenectomy.
