PMC5723364_01
Enhanced computed tomography findings.. (a) Black arrow, pancreas head carcinoma has invaded SMV. (b) White arrow, resection and anastomosis of involved SMV combined with pancreaticoduodenectomy.
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The main PA involved the superior mesenteric vein (SMV; Fig. 1a) and PD combined with SMV and vascular anastomosis was scheduled. Distant tumor metastasis was not evident and thus the scheduled operation proceeded followed by direct anastomosis of the portal trunk and the SMV (Fig. 1b).
Postoperative enhanced computed tomography findings at day 5 after PD.. (a) Black arrow, anastomotic stricture has caused dilated intrahepatic duct; white arrow accompanying complete thrombosis of left liver. (b) White arrow, removal of a part of the portal vein thrombosis.
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Follow-up ultrasonography showed decreased left PV flow and enhanced computed tomography at day 5 showed complete portal thrombosis of the left liver (Fig. 2a). We then attempted thrombectomy via the umbilical portal vein or the main portal trunk under cut-down, but little thrombus was removed (Fig. 2b).
Postoperative enhanced computed tomography findings at day 30 after PD.. Biliary obstruction has improved. Impacted portal thrombus has disappeared and portal flow in left liver has recovered after thrombolytic drug therapy.
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This approach dramatically improved obstructive jaundice and obliterated the organized thrombosis by day 30 (Fig. 3).