Ono Shigeshi, Yamazoe Shinji, Takigawa Yutaka, Hasegawa Hirotoshi
Department of Surgery, Tokyo Dental College Ichikawa General Hospital, 5-11-13 Sugano, Ichikawa, Chiba, Japan.
Department of Radiology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan.
Radiol Case Rep. 2022 Feb 7;17(4):1246-1250. doi: 10.1016/j.radcr.2022.01.036. eCollection 2022 Apr.
Post-pancreaticoduodenectomy hemorrhage is a life-threatening complication that usually occurs in skeletonized arteries. Venous hemorrhage is a rarer complication, and surgical management is often challenging. We herein report the case of an 80-year-old man who suffered from prolonged pancreatic fistula and long-term drainage tube placement, which could cause late post-pancreaticoduodenectomy hemorrhage from the confluence of the splenic and extrahepatic portal veins. An intrahepatic posterior portal venous branch was percutaneously punctured, and the splenic vein was embolized using coils and a vascular plug. A balloon-expandable covered stent was also placed from the superior mesenteric vein to the main portal vein to cover the confluence, which required a system as small as 8-F. Portal venography revealed good patency without extravasation. Thereafter, antithrombotic and antibacterial treatments were successfully administered without any additional interventions. He remained well without any evidence of thrombosis or indolent infection 19 months after endovascular treatment. The endovascular coil and cover technique with prolonged adjuvant therapy is a feasible alternative for managing such critical situations.
胰十二指肠切除术后出血是一种危及生命的并发症，通常发生在骨骼化动脉。静脉出血是一种较罕见的并发症，手术治疗往往具有挑战性。我们在此报告一例80岁男性患者，该患者患有长期胰瘘并长期放置引流管，这可能导致胰十二指肠切除术后晚期脾静脉与肝外门静脉汇合处出血。经皮穿刺肝内门静脉后支，使用弹簧圈和血管塞栓塞脾静脉。还从上肠系膜静脉至门静脉主干置入了球囊可扩张覆膜支架以覆盖汇合处，这需要一个小至8F的系统。门静脉造影显示通畅良好，无外渗。此后，成功进行了抗血栓和抗菌治疗，无需任何额外干预。血管内治疗19个月后，他情况良好，没有任何血栓形成或隐匿性感染的迹象。采用延长辅助治疗的血管内弹簧圈和覆膜技术是处理此类危急情况的一种可行替代方法。
