Successful Treatment of Portal Hypertensive Enteropathy Resulting from Portal Vein Obstruction after Pancreatoduodenectomy: A Case Report

A 59-year-old man underwent pylorus-preserving pancreaticoduodenectomy with resection of the portal vein and intraoperative radiotherapy for cancer of the head of the pancreas. Three years later, he developed recurring episodes of hematemesis and tarry stool occurred repeatedly. Upper gastrointestinal endoscopy and colonoscopy did not reveal any bleeding points. Abdominal angiography also did not reveal any bleeding points, however, it showed obstruction of the portal vein. Superior mesenteric artery angiography showed stagnant and unclear flow in the collaterals. Therefore, the bleeding was considered to be due to portal hypertension induced by portal vein obstruction. Graft anastomosis between the superior mesenteric vein branch and inferior vena cava was performed to ameliorate the portal hypertension. One year after the graft anastomosis, no bleeding from the digestive tract was noted. Late complications of portal vein coresection include repeated bleeding from the digestive tract resulting from anastomotic obstruction of the portal vein. Decompression of the portal vein by graft anastomosis between the superior mesenteric vein and inferior vena cava should be considered as one of the effective treatment options for intractactable gastrointestinal bleeding after pancreaticoduodenectomy.