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Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy

Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD)...

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Autores principales: Watanobe, Ikuo, Ito, Yuzuru, Akimoto, Eigo, Sekine, Yuuki, Haruyama, Yurie, Amemiya, Kota, Miyano, Shozo, Kosaka, Taijiro, Machida, Michio, Kitabatake, Toshiaki, Kojima, Kuniaki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Hepato-Biliary-Pancreatic Surgery 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767262/
https://www.ncbi.nlm.nih.gov/pubmed/26925150
http://dx.doi.org/10.14701/kjhbps.2016.20.1.44
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author Watanobe, Ikuo
Ito, Yuzuru
Akimoto, Eigo
Sekine, Yuuki
Haruyama, Yurie
Amemiya, Kota
Miyano, Shozo
Kosaka, Taijiro
Machida, Michio
Kitabatake, Toshiaki
Kojima, Kuniaki
author_facet Watanobe, Ikuo
Ito, Yuzuru
Akimoto, Eigo
Sekine, Yuuki
Haruyama, Yurie
Amemiya, Kota
Miyano, Shozo
Kosaka, Taijiro
Machida, Michio
Kitabatake, Toshiaki
Kojima, Kuniaki
author_sort Watanobe, Ikuo
collection PubMed
description Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167.
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spelling pubmed-47672622016-02-26 Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy Watanobe, Ikuo Ito, Yuzuru Akimoto, Eigo Sekine, Yuuki Haruyama, Yurie Amemiya, Kota Miyano, Shozo Kosaka, Taijiro Machida, Michio Kitabatake, Toshiaki Kojima, Kuniaki Korean J Hepatobiliary Pancreat Surg Case Report Portal vein thrombosis (PVT) is a rare but serious postoperative complication of pancreaticoduodenectomy (PD). We reported a case of late-onset postoperative PVT with hemorrhage from the common hepatic artery (CHA) in a 73-year-old man who underwent pylorus-preserving pancreaticoduodenectomy (PPPD) for duodenum papilla cancer, followed by reconstruction using the modified Child's technique. The pancreaticojejunostomy was achieved by end-to-side, 2-layer invagination anastomosis without pancreatic duct stenting. Drain removal and hospital discharge were scheduled on postoperative day (POD) 18, but blood-stained fluid in the drain and sudden hematemesis were noted. Emergency surgery was performed because PVT and imaging findings were suggestive of necrosis of the lifted jejunum. Although no jejunal necrosis was identified during surgery, bleeding from the side of the CHA was detected and the bleeding point was suture-closed to achieve hemostasis. We suspected late-onset postoperative arterial hemorrhage and subsequent hematoma formation, which caused portal vein compression and PVT formation. We chose a conservative treatment strategy for PVT, taking into account the operation time, intraoperative vital signs and blood flow in the portal vein. Despite the complicated postoperative course, he was discharged home in a fully ambulatory state on POD 167. Korean Association of Hepato-Biliary-Pancreatic Surgery 2016-02 2016-02-19 /pmc/articles/PMC4767262/ /pubmed/26925150 http://dx.doi.org/10.14701/kjhbps.2016.20.1.44 Text en Copyright © 2016 by The Korean Association of Hepato-Biliary-Pancreatic Surgery http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Watanobe, Ikuo
Ito, Yuzuru
Akimoto, Eigo
Sekine, Yuuki
Haruyama, Yurie
Amemiya, Kota
Miyano, Shozo
Kosaka, Taijiro
Machida, Michio
Kitabatake, Toshiaki
Kojima, Kuniaki
Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title_full Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title_fullStr Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title_full_unstemmed Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title_short Postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
title_sort postoperative portal vein thrombosis and gastric hemorrhage associated with late-onset hemorrhage from the common hepatic artery after pancreaticoduodenectomy
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4767262/
https://www.ncbi.nlm.nih.gov/pubmed/26925150
http://dx.doi.org/10.14701/kjhbps.2016.20.1.44
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