Abstract
The subject, a 55-year-old woman received pylorus-preserving pancreatoduodenectomy for the treatment of a cancer of the duodenal papilla. The rupture of a hepatic artery aneurysm, as a postoperative complication, was treated with an embolization procedure, which was followed by a small amount of blood found several times in the drained fluid. A hemorrhage from the portal system was suspected but the spontaneous hemostasis occurred during the subsequent period. An abdominal CT indicated occlusion of the main portal system and the subsequent development of collateral circulation, which caused melena. Due to obstruction of the portal system and portal hypertension, a hemorrhage from the superior mesenteric varices was suspected. During the past two years, the patient has repeatedly hospitalized due to melena. In September 2003, since the episode of melena has occurred on a daily basis, the patient was transferred to our hospital. Transcutaneous transhepatic portography indicated a complete closure of the portal trunk and the evident development of collaterals into and away from the liver. Detecting that the stenotic region was hard and affected the entire luminal periphery, the section was dilated by using a cutting balloon, followed by the placement of 2 SMART Stents in a “stent-in-stent” fashion.
The residual collateral away from the liver was embolized by using a sclerosing agent. The stent patency has been maintained for 24 months after the procedure with no development of melena. Aggressive interventional radiology may be indicated even when an obstruction has existed for several years.
