Successful Treatment with Partial Splenic Embolization for Variceal Hemorrhage around the Hepaticojejunostomy Site after Pancreaticoduodenectomy: A Case Report

Abstract

An 85-year-old woman was diagnosed with locally advanced pancreatic carcinoma involving the superior mesenteric artery and portal vein. She underwent subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection after chemoradiotherapy. The postoperative course was uneventful. However, she was readmitted to our hospital with anemia and melena 3 months postoperatively. CT showed an obstructed portal vein and formation of collaterals adjacent to the hepaticojejunostomy site. Double-balloon endoscopy revealed red color sign-positive varices around the hepaticojejunostomy site, and hemorrhage from the varices was diagnosed. Endoscopic therapy was not possible because it was difficult to maintain a table position for endoscopy. Therefore, partial splenic embolization (PSE) was performed to reduce portal venous pressure and control the hemorrhage. Melena and anemia have not occurred after PSE. Ectopic variceal hemorrhage caused by extrahepatic portal vein obstruction is a lethal complication after intraperitoneal surgery, and early detection and treatment of the hemorrhagic source remain difficult. No guidelines for variceal hemorrhage around the hepaticojejunostomy site have been established. This case suggests that PSE should be considered as treatment for variceal hemorrhage around the hepaticojejunostomy site.