Stent placement for main portal vein occlusion to eradicate ectopic varices after pancreatoduodenectomy.

Abstract

Ectopic varices bleeding around the choledochojejunostomy site, potentially caused by portal vein occlusion, is a rare complication following pancreatoduodenectomy. In this report, we present a case of ectopic varices around the choledochojejunostomy site after pancreatoduodenectomy. A 55-year-old man who underwent pancreatoduodenectomy with portal vein reconstruction for pancreatic ductal adenocarcinoma suffered from hematochezia. Contrast-enhanced computed tomography revealed total occlusion of the main portal vein and ectopic varices around the choledochojejunostomy anastomosis site. An attempt at endoscopic hemostasis using clipping was unsuccessful. Consequently, a main portal vein stent was inserted to eliminate the varices. We successfully restored blood flow in the portal vein and eradicated the varices. Additionally, endoscopic changes were directly visualized using double-balloon endoscopy. Therefore, portal vein stent placement may be an effective treatment option for ectopic variceal bleeding around the choledochojejunostomy site following pancreatoduodenectomy.