A Case of Acute Pancreatitis Due to Compression of Postoperative Portal Vein Thrombosis That Originated from a Portal Vein Aneurysm

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 55; no. 4; pp. 251 - 259
• Main Authors: Atarashi, Miyuki, Kawamoto, Shunji, Yamamoto, Kota, Terashima, Takahiro
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.04.2022
• Subjects: extrahepatic portal vein aneurysm; portal vein thrombus; postoperative pancreatitis
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2021.0005

A 56-year-old woman who was a Jehovah’s Witnesses was diagnosed with advanced gastric cancer (cT3, N0, M0) and a pancreatic cystic tumor. Preoperative abdominal CT indicated an extrahepatic portal vein aneurysm with a diameter of 22 mm. Total gastrectomy plus distal pancreatectomy with splenectomy were performed. Epigastric pain occurred on postoperative day 11. CT revealed a massive portal vein thrombus from the level of the superior mesenteric vein to the bifurcation of the hepatic hilum. Thrombectomy was performed under laparotomy, and thereafter urokinase was administered by intermittent infusion through a catheter placed in a branch of the superior mesenteric vein. The day after the reoperation, abdominal CT revealed massive ascites with a high level of amylase and the thrombosed portal vein aneurysm compressing the body of the pancreas, resulting in development of acute pancreatitis and a pancreatic fistula. Continuous abdominal irrigation followed by a pancreatic duct stent indwelled via the papilla of Vater was associated with improvement of pancreatitis and pancreatic fistula. The portal vein thrombus was gradually reduced in size by a use of warfarin. We report this case as a rare example of a portal vein aneurysm that developed into a postoperative portal vein thrombus and compressed the body of the pancreas, causing pancreatitis and pancreatic fistula at the stump.