Inomata Yushi, Naito Takeo, Hiratsuka Takashi, Shimoyama Yusuke, Moroi Rintaro, Shiga Hisashi, Kakuta Yoichi, Kayada Kimiko, Ohara Yuki, Asano Naoki, Aoki Shuichi, Unno Michiaki, Masamune Atsushi
Division of Gastroenterology Tohoku University Graduate School of Medicine Miyagi Japan.
Department of Surgery Tohoku University Graduate School of Medicine Miyagi Japan.
DEN Open. 2023 Jul 10;4(1):e255. doi: 10.1002/deo2.255. eCollection 2024 Apr.
A 69-year-old woman, a long-term survivor of subtotal stomach-preserving pancreatoduodenectomy with the splenic vein resection for pancreatic cancer, visited our hospital with a chief complaint of bloody stools. Previously, she was diagnosed with varices in the ascending colon due to left-sided portal hypertension after pancreatoduodenectomy by computed tomography and colonoscopy. After emergency hospitalization, she went into shock, and blood tests showed acute progression of severe anemia. Computed tomography showed a mosaic-like fluid accumulation from the ascending colon to the rectum. She was diagnosed with ruptured varices in the ascending colon. Emergency colonoscopy was performed, and treatment with endoscopic injection sclerotherapy using -butyl-2-cyanoacrylate was successful. Ectopic varices occur at any location other than the esophagus and stomach, and colonic varices are rare among them. They are mostly caused by portal hypertension due to liver cirrhosis. However, with the trend of improving the prognosis for patients with pancreatic cancer, we should occasionally pay attention to the development of ectopic varices including colonic varices in patients who have undergone pancreatoduodenectomy with superior mesenteric and splenic veins resection. Treatment methods for colonic varices varied from case to case, including conservative therapy, interventional radiology, and endoscopic procedure. In this case, endoscopic injection sclerotherapy was successfully performed without any complications. To the best of our knowledge, this is the first study to report successful treatment with endoscopic injection sclerotherapy for varices in the ascending colon caused by left-sided portal hypertension after pancreatoduodenectomy. Colonic varices should be considered in patients with obscure gastrointestinal bleeding after pancreatoduodenectomy.
一名69岁女性，因胰腺癌接受保留部分胃的胰十二指肠切除术并切除脾静脉，是该手术的长期幸存者，因便血为主诉前来我院就诊。此前，通过计算机断层扫描和结肠镜检查，她被诊断为胰十二指肠切除术后因左侧门静脉高压导致升结肠静脉曲张。紧急住院后，她陷入休克，血液检查显示严重贫血急性进展。计算机断层扫描显示从升结肠到直肠有马赛克样液体聚集。她被诊断为升结肠静脉曲张破裂。进行了紧急结肠镜检查，使用丁基-2-氰基丙烯酸酯进行内镜注射硬化治疗取得成功。异位静脉曲张发生在食管和胃以外的任何部位，其中结肠静脉曲张较为罕见。它们大多由肝硬化导致的门静脉高压引起。然而，随着胰腺癌患者预后改善的趋势，我们应偶尔关注接受肠系膜上静脉和脾静脉切除的胰十二指肠切除术患者中包括结肠静脉曲张在内的异位静脉曲张的发生。结肠静脉曲张的治疗方法因病例而异，包括保守治疗、介入放射学和内镜手术。在本病例中，内镜注射硬化治疗成功实施且无任何并发症。据我们所知，这是首例报道使用内镜注射硬化治疗胰十二指肠切除术后左侧门静脉高压导致的升结肠静脉曲张取得成功的研究。胰十二指肠切除术后不明原因胃肠道出血的患者应考虑结肠静脉曲张。
