A Case of Extrahepatic Portal Venous Obstruction after 8 Years Pancreaticoduodenectomy Effectively Treated with Transjuguler Intrahepatic Portoplasty

• Published in: The Japanese Journal of Gastroenterological Surgery Vol. 30; no. 9; pp. 1932 - 1936
• Main Authors: Sano, Katsuhide, Nakasato, Yuichi, Yokota, Tokuyasu, Tanaka, Kazuro, Aoki, Teruaki, Takeuchi, Kosuke, Futagawa, Yasuro, Mizunuma, Kimiyoshi, Inagaki, Yoshinori
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society of Gastroenterological Surgery 1997
• Subjects: prehepatic portal vein obstruction; selfexpandable metalic stent; transjugular intrahepatic portoplasty
• ISSN: 0386-9768; 1348-9372
• DOI: 10.5833/jjgs.30.1932

A 78-year-old man, who had been operated on by the Child procedure for inferior bile duct carcinoma eight year earlier, was admitted to the hospital because of melena with portal hypertension. Enhancement-CT and portogram of celiac angiography revealed a tortuous and bent portal trunk with prehepatic portal hypertension and hepatofugal collateral circulation. There was no evidence of recurrence ofthe previous carcinoma. Transjugular intrahepatic balloon angioplasty was performed to dilate the stenosis of the portal trunk, but it did not have a sufficienteffect on the stenosis. Therefore, a 10-mm, self-expandable metalic stent (wallstent®) was implanted, creating a nearly normal lumen without a pressure gradient. This procedure is transjuguler intrahepatic portoplasty (TIPP). After TIPP for the stenosed portal trunk, portal hypertension was relieved and there was no opacification of the collateral vessels. In the post-TIPP state, maximal velocity was decreased but flow volume was increased at the portal trunk as compared with the pre-TIPP state. The patient's clinical course was satisfactory and he was discharged on the 11th post-TIPP day. The patient had no recurrent melena andanemia for 20 months after this procedure. This procedure was considered useful for the portal obstruction, and this case was the 1st case of TIPP in Japan.