MD Creighton University School of Medicine Phoenix, Arizona
Mays Almohammedawi, MBChB1, Ali Alshati, MD2, Aaron Wittenberg, MD3, David Weitz, MD3, Dimas Kosa, MD2, Toufic Kachaamy, MD3; 1Baghdad University College of Medicine, Phoenix, AZ; 2Creighton University School of Medicine, Phoenix, AZ; 3Cancer Treatment Centers of America, Phoenix, AZ
Introduction: Portal vein (PV) and superior mesenteric vein (SMV) stenosis can result from various pathologic processes including pancreatic cancer. Their clinical manifestations include portal hypertension (PH) with life-threatening variceal bleeding, refractory ascites, and mesenteric ischemia. In this abstract, 4 cases who underwent stenting are presented.
Methods: Case 1 is a 58-year-old woman with a history of pancreatic cancer status post Whipple resection, presented with worsening diarrhea, ascites, and malnutrition. Stool testing, colonoscopy with biopsies were negative. Ascitic fluid analysis was consistent with PH with no evidence of cirrhosis. Abdominal imaging showed ill-defined pancreatic body infiltrative mass with significant narrowing of the PV with resultant small bowel and colonic thickening. She underwent SMV/PV stenting which resulted in the resolution of diarrhea and bowel thickening. She went off total parenteral nutrition with 22 kg weight gain and was able to receive systemic anticancer therapy (SAT) and survived for 18 months afterward. Three other cases with similar preservations and varying degrees of refractory ascites, diarrhea, malnutrition, and bowel wall thickening on imaging. They all underwent PV or SMV stenting. Case 2 is a 68-year-old woman who experienced relief of symptoms but elected hospice care and passed away a month later, after developing SMV stent thrombosis despite oral anticoagulation. Case 3 is a 58-year-old woman who had PV and SMV stenoses. She developed refractory bleeding immediately after stenting and consequently died. Case 4 is a 66-year-old man who achieved symptoms resolution. His symptoms recurred due to stent thrombosis 6 weeks later. After thrombectomy, he improved and was alive at 4 months, on aspirin, enoxaparin, and SAT, with no recurrence of symptoms. Discussion: PV and SMV stenosis caused by pancreatic cancer can result in varying degrees of bowel ischemia, malnutrition, refractory ascites and often leads to death. It is often unrecognized and clinical findings are attributed to the cancer itself. PV/SMV stenting is possible and can reverse PH, ascites, bowel ischemia, and malnutrition. Anticoagulation can decrease the risk of venous thrombosis associated with stenting but coexistent PH presents a challenge to anticoagulation. Further studies are needed to determine the targeted population that will benefit from stenting and when to start anticoagulation or antiplatelet therapy.
A) Abdominal CT scan showing PV stenosis B) PV stent placement process. Contrast failed to pass through the narrowed area
C) Stent is successfully placed. D) Abdominal CT scan status post PV stent placement
Disclosures: Mays Almohammedawi indicated no relevant financial relationships. Ali Alshati indicated no relevant financial relationships. Aaron Wittenberg indicated no relevant financial relationships. David Weitz indicated no relevant financial relationships. Dimas Kosa indicated no relevant financial relationships. Toufic Kachaamy indicated no relevant financial relationships.