Abstract
We report an unusual case of portal hypertension complicated by repeated major gastrointestinal hemorrhage following bile duct cancer surgery, in which it was difficult to identify the source of the bleeding. The patient was a 59-year-old man with central bile duct cancer who underwent bile duct resection plus hepatojejunostomy (Roux-en-Y). Angiography was ultimately performed after difficulty in identifying the source of the frequent major gastrointestinal hemorrhages which began approximately 1 year and 6 months postoperatively. A diagnosis was made of portal hypertension due to extrahepatic portal occlusion secondary to cancer recurrence, and hemorrhage from hepatopetal varices arising in the portal area of the anastomosed jejunum. Treatment consisted of H-shunting from the dilated jejunal vein to the inferior vena cava plus banding of the dilated jejunal vein. Although there were no subsequent recurrences of gastrointestinal hemorrhage, the patient developed lung metastasis from his recurrent cancer and died 11 months later. porto-jejunal varices were confirmed at autopsy. This is the first report of hemorrhage from ectopic varices in the anastomosed jejunum following bile ductcancer surgery, and we consider it a very interesting case.
