Percutaneous transhepatic portal vein stent-graft placement and jejunal varices embolization after hepaticojejunostomy

Acquired portal vein (PV) stenosis or occlusion is most commonly seen after liver transplantation. In the nontransplant population, PV stenosis or occlusion can occur with pancreatitis, tumor encasement, and postsurgical complications. Portal hypertension resulting from PV stenosis or occlusion can cause variceal bleeding in the gastrointestinal tract. Bleeding from ectopic varices, such as duodenum, jejunum, ileum, and rectum, is rare and can be life threatening in patients with portal hypertension. There are several treatment options for the management of PV stenosis or occlusion combined with variceal bleeding such as PV stenting, transjugular intrahepatic portosystemic shunt (TIPS) and transhepatic or transsplenic embolization of varices. Herein we report a case of jejunal variceal bleeding with postoperative PV occlusion successfully managed by PV stent-graft placement and variceal embolization.