Successful Treatment by Expandable Metallic Stent for Anastomotic False Aneurysm Secondary to Portal Vein Stenosis after Pancreatoduodenectomy with Combined Resection of the Portal Vein

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 49; no. 8; pp. 812 - 818
• Main Authors: Sano, Shusei, Terada, Takuro, Mitsui, Takeshi, Kurebayashi, Hidetaka, Saito, Kenichiro, Amaya, Susumu, Takashima, Yoshihiro, Iida, Yoshiro, Munemoto, Yoshinori, Yamashiro, Masashi, Miyayama, Shiro
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 01.08.2016
• Subjects: expandable metallic stent; pancreatoduodenectomy; pseudoaneurysm
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.2015.0171

The patient was a 69-year-old woman who underwent a subtotal stomach-preserving pancreatoduodenectomy with combined resection and reconstruction of portal vein for pancreatic head cancer. She was found to have portal vein stenosis 2 weeks after the surgery. Abdominal dynamic CT performed 3 months after the surgery revealed a 24-mm cystiform aneurysm of the extrahepatic portal vein without any findings of portal hypertension or cancer recurrence, which was located just close to the anastomosis portion at the side of the liver. The rapidly-enlarged aneurysm was considered to have a risk of rupture or bleeding, therefore she underwent a percutaneous transhepatic portography, and an expandable metallic stent (non-covered type, 10 mm×40 mm) was inserted subsequently to dilate the anastomotic stenosis. The pseudoaneurysm decreased in size and disappeared completely 6 months after the stenting. We considered that the anastomotic false aneurysm secondary to the portal vein stenosis occurred because of abnormal blood streams resulting from the portal vein stenosis, distortion and deformity of the portal vein, and vulnerability around the anastomotic site. Stent placement dilated the portal vein stenosis and could have led to the disappearance of the aneurysm of the portal vein.