Endovascular treatment of recurrent gastrointestinal bleedings in patients with portal vein stenosis after pancreatoduodenal resection

Abstract

The OBJECTIVE was to show a potential and efficiency of endovascular methods in treatment of patient with portal vein stenosis after pancreatoduodenal resection complicated by the development of varices in the portomesenteric basin and recurrent gastrointestinal bleeding. METHODS AND MATERIALS. We presented the results of treatment of two patients who previously underwent pancreatoduodenal resection for pancreatic head cancer. 2 patients were admitted to the Clinic of the Research Institute of Surgery and Emergency Medicine of Pavlov University with a clinical picture of recurrent gastrointestinal bleeding. RESULTS. Both patients had no visible bleeding site with endoscopy, but had recurrent melena and hemoglobin loss. On radiological imaging we found a portal vein stenosis with a significant varicose transformation of the mesenteric basin. Endovascular stent placement for portal vein stenosis was performed in both cases with no recurrence of bleedings and no complications. CONCLUSION. Portal vein stenosis after pancreatoduodenal resection is a rare complication, which can manifest in recurrent gastrointestinal bleeding with no visible bleeding site on endoscopy. Endovascular methods are feasible and safe in treatment of portal vein stenosis with no relapse. Multidisciplinary approach in diagnostic and treatment of such patients allow to identify and remove the cause of recurrent bleeding.