[Massive gastrointestinal hemorrhage from a hepaticojejunostomy in pancreatogenic mesenteric vein thrombosis. Diagnosis and therapy]

Abstract

Gastrointestinal hemorrhage in a patient with a biliodigestive anastomosis necessitates exclusion of a bleeding source in the region of the choledocho- or hepaticojejunal anastomosis. This cannot be achieved by endoscopic methods. The source of bleeding can sometimes, though rarely, be localised by performance of selective angiography during hemorrhage. Laparotomy with exploration of the anastomosis during such an episode is at the same time a diagnostic and a therapeutic intervention. The surgical procedure of choice is de-anastomosis, resection of the bypassed jejunal loop and formation of a hepatico-duodenostomy.