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Review
. 2023 Sep 4:39:22.
doi: 10.5758/vsi.230053.

Ectopic Variceal Bleeding from the Hepaticojejunostomy due to Extrahepatic Portal Vein Occlusion: How to Treat?

Ahram Han  1 , Seung-Kee Min  1
Affiliations
Review

Ectopic Variceal Bleeding from the Hepaticojejunostomy due to Extrahepatic Portal Vein Occlusion: How to Treat?

Ahram Han et al. Vasc Specialist Int. .

Abstract

Atypical variceal bleeding, which primarily stems from extrahepatic portal vein obstruction (EHPVO), is a severe complication of pancreatic hepatobiliary surgery. This review provides insights into this condition's incidence, diagnosis, and management strategies. The treatment modalities for atypical variceal bleeding resulting from EHPVO range from endoscopic intervention to surgical procedures, including direct variceal ligation and shunt surgery. Here, we discuss the efficacy and potential limitations of each treatment approach. Additionally, we explored the utility and therapeutic advantages of the meso-Rex shunt, a particularly promising surgical technique for mitigating the hemodynamic and metabolic impacts of EHPVO.

Keywords: Esophageal and gastric varices; Portal hypertension; Portosystemic shunt.

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Conflict of interest statement

CONFLICTS OF INTEREST

Ahram Han and Seung-Kee Min have been the editorial board members of the VSI since 2019. They were not involved in the review process. Otherwise, no potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
Preoperative computed tomography scan demonstrating a cavernous formation around the porta hepatis (A) and portal vein thrombosis (B). Adapted from the article by Oh et al. (Vasc Specialist Int 2020;36:186-192) [5].
Fig. 2
Fig. 2
Preoperative computed tomography scan revealing the obliteration of the portal vein (thin arrows in coronal view [A] and axial view [B]). Gastric and hepaticojejunostomy varices (thick arrows in [A]) due to portal hypertension were observed. Adapted from the article by Cho and Min (Vasc Specialist Int 2022;38:27) [36].
Fig. 3
Fig. 3
Intraoperative findings depicting the procedure of the modified coronary vein-left portal vein (LPV) shunt. (A) Coronary vein isolation. (B) LPV isolation. (C) Distal end-to-end anastomosis of the great saphenous vein (GSV) graft to the LPV. (D) Proximal end-to-end anastomosis of the coronary vein to the GSV. Adapted from the article by Oh et al. (Vasc Specialist Int 2020;36:186-192) [5].
Fig. 4
Fig. 4
Follow-up computed tomography after two years displaying complete patency of the great saphenous vein graft (thick arrows) and coronary vein (thin arrows). Adapted from the article by Cho and Min (Vasc Specialist Int 2022;38:27) [36].
Fig. 5
Fig. 5
Treatment algorithm for atypical variceal bleeding due to extrahepatic portal vein obstruction. EHPVO, extrahepatic portal vein obstruction; PV, portal vein; CT, computed tomography; USG, ultrasonography; LPV, left portal vein.
See this image and copyright information in PMC

References

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