Abstract
We report a case of a 64-year-old female patient who underwent a right lobectomy of the liver (including total resection of the caudate lobe), dissection of the group 2 lymph nodes, left hepaticojejunostomy (Roux-en-Y fashion), and reconstruction of the portal vein (end-to-end anastomosis between the main portal vein and the left portal branch) for treatment of hepatic hilar bile duct cancer in 1996. In 2001, the anastomotic site of the hepaticojejunostomy was dissected and re-anastomosed due to gastrointestinal bleeding caused by variceal rupture in the jejunal loop. In 2006, splenectomy was performed for recurrence of gastrointestinal bleeding due to another variceal rupture in the jejunal loop. Portal venography performed perioperatively showed a decrease in portal blood flow into the liver via the jejunal varices and an increase in portal blood flow into the liver via the left gastric vein. She had two jejunal variceal ruptures at five-year intervals after extrahepatic portal obstruction and underwent successful treatments.
Highlights
Bleeding from varices in the jejunal loop due to extrahepatic portal obstruction after reconstruction of the biliary tract is rare, and the treatment of such bleeding is difficult and the prognosis is poor
We report a case in which a patient is alive and well 11 years after surgery for bile duct cancer in the hepatic hilus after undergoing two operations for postoperative variceal rupture in the afferent jejunal loop
The patient was a 64-year-old female who underwent a right lobectomy of the liver, dissection of the group 2 lymph nodes, left hepaticojejunostomy (Roux-en-Y fashion), and reconstruction of the portal vein for treatment of bile duct cancer in the hepatic hilus on July 25, 1996
Summary
Bleeding from varices in the jejunal loop due to extrahepatic portal obstruction after reconstruction of the biliary tract is rare, and the treatment of such bleeding is difficult and the prognosis is poor. We report a case in which a patient is alive and well 11 years after surgery for bile duct cancer in the hepatic hilus after undergoing two operations for postoperative variceal rupture in the afferent jejunal loop. Bleeding points could not be confirmed by red blood cell scintigraphy, but angiography via the superior mesenteric artery showed a significantly dilated jejunal vein and communication with the intrahepatic portal vein.
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