Watanabe Y, Sato M, Abe Y, Ueda S, Kashu H, Nakamura Y, Kawachi K
Second Department of Surgery, Ehime University, Japan.
Hepatogastroenterology. 1998 Mar-Apr;45(20):551-3.
BACKGROUND/AIMS: Portal venous stenosis caused by cancer invasion has been difficult to treat and patients do not have any treatment options. On the other hand, protal venous stents have been applied to patients with variceal haemorrhaging associated with portal vein thrombosis. However, there have not been any reports concerning portal venous stents for malignant portal stenosis. The aim of this report was to apply metallic stent for malignant portal stenosis to reduce portal hypertension and restore portal venous blood flow, which in turn leads to the recovery of liver function.
Two patients with portal hypertension caused by malignant portal stenosis were treated by metallic stent implantation. In one case, the stent was applied intraoperatively via the ileal vein and in the other case, it was applied postoperatively via transhepatic portal cannulation.
In the first case, portal pressure monitored before and after placement of the stent was 350 mmH2O and 200 mmH2O, respectively. Liver function tests showed normalization after stent placement. In the second case, over 3000 ml of ascites, which were drained through the drainage catheter every day, could be reduced remarkably, and one week later, the catheter could be withdrawn. Portal pressure before and after embedding the stent was 410 and 275 mmH2O, respectively. Both patients were discharged from the hospital and their recovery was uneventfully.
Both cases had an uneventful postoperative course, with normalization of liver function and cessation of ascites on the next postoperative day in case 2. Thus, portal venous stent should be considered a viable option for the treatment of malignant portal stenosis.
