Jejunal loop varices resulting from extrahepatic portal obstruction after pancreatoduodenectomy treated with embolization via a transmesenteric approach

Bleeding from jejunal loop varices caused by portal vein (PV) stenosis is one of the most critical and refractory late complications following pancreatoduodenectomy (PD). An 82-year-old man who underwent PD 14 years previously for carcinoma of the papilla of Vater with a recurrence in the superior mesenteric lymph nodes with PV stenosis and jejunal loop varisces, was admitted to the emergency room with massive melena. Preoperative 3D-CT could identified both the obvious inflow to the jejunal loop varices through a mesenteric vein and the collateral vessel to the PV through the left gastric vein. Surgical transmesenteric embolization of the jejunal loop varices via a radiologic interventional technique could be performed as planned through the mesenteric vein following preoperative 3D-CT. Postoperative CT showed clear deposition of embolic materials in the varices and stable patency of PV. Bleeding did not recur after the procedure. Based on the simulation using 3D-CT, surgical mesenteric embolization of jejunal loop varices could be performed safely and is one of the most useful therapeutic options for bleeding from the varices.