Pylorus-Preserving Pancreaticoduodenectomy for a Gastrointestinal Stromal Tumor of the Duodenum with Marked Bleeding after Selective Transarterial Embolization

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A 67-year-old man presented complaining of tarry stool. His hemoglobin level was 3.8 g/dl. Upper gastrointestinal endoscopy revealed a 7 cm submucosal tumor with a deep ulcer near the papilla of Vater. Contrast-enhanced CT showed the tumor was the origin of the marked bleeding. Melena from the tumor continued after admission, and we were requested to stop the bleeding immediately. Abdominal angiography revealed the tumor was supplied from the anterior and posterior superior pancreaticoduodenal arteries, inferior pancreaticoduodenal artery, and middle colonic artery. Portal vein flow was enhanced in the early phase, indicating an AV shunt. Selective transarterial embolization (TAE) was performed through all the pancreaticoduodenal arteries except for the colonic artery. The TAE was effective. After 9 days, pylorus preserving-pancreaticoduodenectomy with partial colonic resection was performed. Based on the histopathological findings, a final diagnosis of duodenal gastrointestinal tumor was made. He lost about 600 g blood volume during the operation, which was similar to conventional operations. Although few articles reported TAE from primary gastrointestinal stromal tumors, TAE may be useful to avoid of emergency operation, and reduce intraoperative bleeding during the operation.
一般社団法人日本消化器外科学会の論文