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Percutaneous transhepatic portal vein stenting as rescue treatment for recurrent oesophageal variceal bleeding in a 31-year-old woman with haepatocellular carcinoma in a non-cirrhotic liver
  1. Colin Andreas Jan van Kalkeren1,
  2. Zlatan Mujagic2,
  3. Jef Verbeek1 and
  4. Michiel W de Haan3
  1. 1Division of Gastroenterology-Hepatology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
  2. 2Division of Gastroenterology-Hepatology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
  3. 3Department of Radiology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
  1. Correspondence to Professor Michiel W de Haan; m.de.haan{at}mumc.nl

Abstract

A 31-year-old woman with hepatocellular carcinoma suffered from recurrent oesophageal variceal bleeding due to portal hypertension, which was caused by severe compression of the portal vein by metastatic lymph nodes. Endoscopic band ligation and pharmacological treatment did not suffice to prevent recurrence of variceal bleeding. Eventually, after the fifth variceal bleeding within 6 months, the patient was admitted to the intensive care unit in a haemodynamic shock. A Sengstaken-Blakemore tube was inserted and all treatment options were discussed, but only percutaneous transhepatic recanalisation of the portal vein with stent placement to reduce portal vein pressure was thought to be feasible with any chance to relieve portal vein pressure. After successful portal vein stenting, our patient did not have any recurrent bleeding in the remaining year of her life. We suggest that percutaneous transhepatic portal vein stenting may be a feasible and adequate last line treatment for complications of portal hypertension.

  • portal vein
  • varices
  • hepatic cancer
  • interventional radiology
  • portal hypertension

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Footnotes

  • Contributors CAJvK: Manuscript writing and literature review. ZM, JV and MWdH: Constructive review of manuscript and involved in patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MWdH reports grants from Philips Medical Systems, outside the submitted work. Other authors have nothing to disclose.

  • Patient consent for publication Next of kin consent obatined.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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