We herein present a case of a 59-year-old man who had undergone pylorus preserving pancreaticoduodenectomy with regional lymph node dissection prior to episodes of melena. Series of conventional endoscopic investigations failed to identify the bleeding source. Enhanced computed tomography scan revealed complete obstruction of the main portal vein with numerous collateral veins running towards the hepatic hilus. Comprehensively, hemorrhage from the jejunal varices caused by postoperative portal hypertension was highly suspected. As the jejunal loop was out of reach, adult variable-stiffness colonoscope (AVSC) was utilized to solve the Roux-en-Y anatomy. Numerous telangiectasis and small varices at hepaticojejunostomy were observed and in the mean time, bleeding was noticed and endoclips were placed without any delay. Ectopic variceal bleeding in jejunal loop after pancreaticoduodenectomy is difficult to manage. We believe that AVSC is an alternative device when specialized jejunal endoscopy is not available.
Application of a scoring system based on the detection of both DVT and HITS may be an effective and efficient method of screening for PE after knee arthroplasty.
80 years old man underwent osteosynthesis operation for trochanteric fracture. After two month, a pulsating tumor was detected to the right inguinal region and gradually enlarged. The pseudo aneurysm was noted by CT scan and ultrasound. After the blood flow blocking balloon was inserted into the perforated deep femoral artery, the pseudo aneurysm was exposed and incised. But surgical control of bleeding was difficult by the backflow of the pseudo aneurysm and arteriovenous fistula in the deep femoral artery was identified.
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