Percutaneous Transhepatic Approach for Recanalization of Superior Mesenteric and Portal Vein in a Patient With Pancreatic Neuroendocrine Tumor Presenting With Bleeding Duodenal Varices: A Brief Case Report

Ajit Yadav; Gaurav Gangwani; Nitin Mishra; Arun Gupta

doi:10.1016/j.jceh.2018.03.003

Percutaneous Transhepatic Approach for Recanalization of Superior Mesenteric and Portal Vein in a Patient With Pancreatic Neuroendocrine Tumor Presenting With Bleeding Duodenal Varices: A Brief Case Report

J Clin Exp Hepatol. 2018 Sep;8(3):318-320. doi: 10.1016/j.jceh.2018.03.003. Epub 2018 Mar 30.

Authors

Ajit Yadav¹, Gaurav Gangwani², Nitin Mishra³, Arun Gupta⁴

Affiliations

¹ Senior Consultant, Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.
² Clinical Assistant, Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.
³ Fellow, Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.
⁴ Chairperson, Department of Interventional Radiology, Sir Gangaram Hospital, New Delhi, India.

Abstract

Occlusion of Portal Vein (PV) and Superior Mesenteric Vein (SMV) is a known effect of local infiltration by pancreatic or mesenteric neuroendocrine tumors. Venous occlusion leads to formation of collateral pathways to restore hepatopetal flow in main PV and these collateral pathways can be seen in the form of ectopic (duodenal or jejunal) varices. We present a case of bleeding duodenal varices secondary to SMV occlusion by a locally infiltrating pancreatic neuroendocrine tumor which was successfully treated by coil embolization of varices and SMV stenting of the occluded venous segment after failure of endoscopic glue injection. Various endovascular minimally invasive approaches have been described in literature for recanalization of SMV in such clinical scenarios which maybe challenging to treat for surgical methods. We recommend use of the retrograde transhepatic technique for recanalization of occluded SMV and embolization of associated varices as an alternate treatment option in such scenarios.

Keywords: F, French; PNET, Pancreatic Neuroendocrine Tumor; PV, Portal Vein; SMV, Superior Mesenteric Vein; ectopic varices; neuroendocrine tumor; pancreatic tumor; stenting; superior mesenteric vein occlusion.