Intermittent hemorrhage from biliary varices caused by portal biliopathy after pancreatoduodenectomy successfully treated with trans-ileocolic vein obliteration

 CommentaryBiliary portopathy refers to the biliary changes that occur in patients with portal hypertension because of encirclement of the common duct and gallbladder wall by varices. Besides causing obstruction of the ductal system, varices, like varices elsewhere, can rupture with disastrous consequences. Portal hypertension in this patient might have been caused by the pancreatic cancer with obstruction of the splenic vessels, or perhaps this patient had liver disease we were not told of. Regardless, the authors tried to treat the bleeding by argon plasma coagulation, unfortunately converting a relatively stable, but dangerous, situation to an unstable one, and then had to resort to venous obliteration using cyanoacrylate, which was successful. There is an African proverb that smooth seas do not make skillful sailors. Obviously these sailors were experienced in rough water. The take-home message, however, can be generalized to many situations. Always have a backup plan, because what works in one situation may not work in another and may leave you, at least for the moment, worse off than when you started. The Boy Scout motto “Be prepared” is a good one.Lawrence J. Brandt, MDAssociate Editor for Focal Points

PII: S0016-5107(09)02572-3

doi:10.1016/j.gie.2009.10.009

© 2010 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.