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Portal Vein Bleeding after Pancreatectomy: Diagnosis and Stent Graft Repair - A Consecutive Case Series

Kojiro Suzuki, Tomoki Ebata, Tomohiro Komada, Masaya Matsushima, Takashi Mizuno, Tsuyoshi Igami, Gen Sugawara, Yukihiro Yokoyama, Shinji Naganawa, Masato Nagino

Objective Postoperative bleeding is a severe complication that can occur after pancreatectomy. Bleeding mainly arises from peripancreatic arteries, but the portal venous system can also rarely cause bleeding. This study assessed portal vein bleeding after pancreatectomy. Methods Between November 2013 and August 2016, five patients (three males, two females; median age, 75 years; age range, 66-78 years) with postoperative portal vein bleeding underwent stent graft repair. Angiography and fistulography were performed in four and five patients, respectively. Patients were retrospectively analyzed with regard to radiological findings and clinical outcome. Results All patients developed pancreatic leakage after surgery. Angiography demonstrated portal vein pseudoaneurysm in one patient and no evidence of bleeding in the other three patients. Fistulography demonstrated the peritoneal cavity with pancreatic leakage connecting with the portal venous system in all five patients. Stent grafts achieved hemostasis with portal flow preservation in all patients. Four patients were discharged and one patient died of multiorgan failure in hospital. Conclusions Fistulography is useful to depict sources of portal vein bleeding. Stent grafts appear to offer effective treatment for portal vein bleeding after pancreatectomy.