Portal vein stenting for variceal bleeding at the choledochojejunostomy site in a patient with portal vein occlusion or stenosis: Report of two cases.

Introduction: Gastrointestinal bleeding following hepato-biliary-pancreatic surgery may result from variceal hemorrhage at the choledochojejunostomy site due to portal vein (PV) stenosis. However, accurately determining the underlying cause can be difficult. Moreover, managing such bleeding can be challenging and even unsuccessful. Presentation of case: Case 1: A 60-year-old man underwent pancreatoduodenectomy with PV resection and reconstruction for stage IB pancreatic cancer. Thirty-three months later, he developed variceal bleeding due to portal vein (PV) hypertension and bleeding from varices at the choledochojejunostomy site. PV stenting was performed using percutaneous transhepatic and trans-ileal approaches. No rebleeding occurred at 8 months.Case 2: An 82-year-old man with recurrent hilar cholangiocarcinoma and PV stenosis developed variceal bleeding due to PV hypertension and variceal bleeding at the choledochojejunostomy site. After failed endoscopic therapy, PV stenting via the ileocolic vein was performed. He remained free from bleeding at 12 months. Discussion: PV stenting can be effective for controlling bleeding from choledochojejunostomy varices caused by PV stenosis or occlusion. A bidirectional approach was essential in the occluded case. Literature review indicates high success rates. The need for antithrombotic therapy post-stenting remains unclear. Conclusion: PV stenting is a feasible and effective option for variceal bleeding related to PV stenosis after pancreatoduodenectomy.