2020 Volume 53 Issue 11 Pages 871-881
Extrahepatic portal vein obstruction (EHPO) is a late complication of intraoperative radiotherapy (IORT) and it generally causes portal hypertension, which can, in turn, lead to gastrointestinal bleeding due to varices. A 67-year-old man had undergone pylorus-preserving pancreatoduodenectomy with IORT (25 Gy) for carcinoma of the papilla of Vater 24 years prior to admission. From the eighth year post operation, EHPO and extrahepatic collateral vessel development, which were considered late radiation complications, were detected. He was referred to our hospital for melena. Gastrointestinal endoscopy revealed bleeding from the ectopic varices in the jejunum limb. After the patient underwent endoscopic sclerotherapy of the jejunum limb varices, a Rex shunt was applied as a curative therapy. A right internal jugular vein graft was used to create a jejunal limb vein–portal umbilical bypass. On the fourth day post operation, graft occlusion, due to a thrombus, and intraperitoneal hemorrhage were observed, and reoperation was performed. The thrombus was removed from the graft, and a spiral vein graft made from the left great saphenous vein was used as an interposition graft to recreate the bypass. The patient received anticoagulant therapy on the second postoperative day and was discharged without any thrombus in the graft.
