Endovascular resolution of post-surgical complications in the portal vein: Report of two cases

Abstract

Stenosis of the portal vein is one of the main complications after hepatobiliar and pancreatic surgery, with a reported incidence of 19.6% after pancreaticoduodenectomy and 3% after liver transplant. It is associated with the intraoperative resection of the portal vein, local recurrence of the primary tumor and radiotherapy. The portal lesion secondary to bile drainage catheter insertion is extremely rare or unusual, with few cases described in the literature. This article describes 2 cases: the first of a male patients 49 years old post-operative to liver transplant with partial portal thrombosis and stenosis of the mesoportal joint, and the second a female patient 50 years old with history of cholecystectomy, exploration of the bile duct and placement of Kehr "T" tube with secondary portal lesion. The 2 cases were successfully treated through minimally invasive procedures by an interventionist radiologist.

Keywords: Complications; Fistula; Interventions; Portal; Portal vein; Stents; Transplantation.

Fig. 1

(A) Axial contrasted tomography. Ascitis (blue arrow); thrombosis of the mesoportal joint corresponding to a Yerdel grade III (blue arrowhead); (B) Coronal contrasted tomography. Ascitis (blue arrow); thrombosis in the mesoportal joint (arrowhead), gastric varices with embolization material (yellow arrow); (C) Coronal MIP reconstruction. Portosystemic shunts. Splenorenal (red arrow), gastrosplenic (Green arrow), gastric varices with embolization material (yellow arrow); (D) Doppler ultrasound. Elevation of post-stenosis speed. Ascitis.

Fig. 2

(A) Portography. Portal thrombosis (red arrow) and embolization material at the level of gastric varices (yellow arrow; (B) Portography. Site of stenosis (blue arrow) and portosystemic shunts (green arrow).

Fig. 3

Portography, where stenosis was conquered with the help of hydrophilic guide (red arrow).

Fig. 4

Stent system recovered and mounted on a ball, which was located in the area of the stenosis (yellow arrow).

Fig. 5

Reversion of the area of the stenosis with adequate flow through the stent, without signs of leakage (red arrow).

Fig. 6

Cholangiography through mixed catheter of transparietohepatic derivation of the bile duct with bile catheter 8 Fr (green arrow). Note the absence of portal flow from the bile duct and the reduction of leakage through the stump of the cystic duct. The intrahepatic bile duct is not dilated (blue arrow).

Fig. 7

(A) Display of the portal stent. The stent was introduced mounted on a ball to the site of the defect; (B) the ball was insufflated for its release; (C) control was performed verifying adequate positioning and permeability of the portal without leaks.