1. Obscure overt gastrointestinal (GI) bleed in a long-term follow up after splenectomy and devascularistion for Extrahepatic portal venous obstruction (EHPVO) – a case report
Authors: Sandeep Kumar Verma, Anu Behari, Rajan Saxena
Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow.
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2. Now presented with melena
24 /F underwent splenectomy and devascularization for bleeding due EHPVO in 2007
Now presented with melena
Upper gastrointestinal endoscopy (UGIE) and colonoscopy failed to identify the source.
Tech-sulphur colloid scan preoperatively showed a suspicious activity in third part of duodenum (D3)which could not be confirmed by a repeat endoscopy
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4. Triple phase computed tomography showed large collaterals along the SMV, IMV and right inferior epigastric vessels few of which were prolapsing in the jejunal loop; however no active extravasation could be seen
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5. Laparotomy and intraop enteroscopy done.
Twelve units of packed red blood cells (PRBC) were transfused preoperatively to maintain hemoglobin above 7 gm/d.
Laparotomy and intraop enteroscopy done.
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6. Dilated mesenterico-peritoneal collateral at a site of jejunal loop adherent to previous scar 200cm distal to DJ flexure
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7. Varix bearing segment of jejunum was resected and an end jejunostomy and distal mucous fistula (DMF) was matured
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8. Postoperatively patient had high stoma output for which refeeding was done through intubation of DMF. Patient has done well postoperatively, without bleeding, with improvement in nutrition, and is planned for a mesocaval shunt.
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