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Abstract Background Causes of extrahepatic portal vein obstruction include abdominal surgeries such as pancreaticoduodenectomy. We improved jejunal variceal bleeding due to extrahepatic portal vein occlusion after pancreaticoduodenectomy, by shunting of the testicular vein. Case presentation A 72-year-old man was diagnosed with extrahepatic bile duct cancer and underwent subtotal stomach-preserving pancreaticoduodenectomy 5 years ago. No postoperative complications occurred, adjuvant chemotherapy using gemcitabine hydrochloride was performed, and the patient remained recurrence-free. One year and 6 months post-operation, extrahepatic portal vein stenosis appeared, but no recurrence was noted. However, 4 years and 6 months later, recurrent gastrointestinal bleeding occurred, and the patient was diagnosed with an extrahepatic portal vein obstruction. Double-balloon enteroscopy showed capillary dilatation and varicose veins in the hepaticojejunostomy region, and venous bleeding from collateral blood vessels was diagnosed. A superior mesenteric vein to the right testicular vein shunt operation was performed, following which the gastrointestinal bleeding disappeared, and the anemia improved. Although transient hepatic encephalopathy occurred, conservative treatment relieved it. Double-balloon enteroscopy confirmed the disappearance of abnormal blood vessels. Conclusions A portosystemic shunt operation using the right testicular vein effectively relieved refractory variceal bleeding around the hepaticojejunostomy site in the jejunum due to an extrahepatic portal vein obstruction after pancreaticoduodenectomy.

Abstract Objectives Due to increased number of patients suffering from hydrocephalus (HCP) and lack of data concerning volumetric changes after shunting operations, this study aims to assess the volumetric changes in brain ventricles after successful ventriculoperitoneal (VP) shunt surgery in correlation with clinical improvement. Patient and methods This study included 20 patients; all of them are below the age of 2 years. All the patients had hydrocephalus, were treated surgically with VP shunts, and have clinically improved over the period of study. We measured the volumetric changes radiologically using the fronto-occipital horn ratio (FOHR) over a period of 6 months postoperatively. Results The frontal and occipital horn ratio was calculated in all these patients both pre and postoperatively. There was a significant radiological improvement in the majority of children after the shunt operation. One month postoperatively, the FOHR decreased to about 85% of its preoperative value in average. The FOHR was found to be significantly improving with time over a period of 6 months reaching 63% of its preoperative value. Conclusion Successful treatment of HCP in infants via VPS seems to be of benefit in decreasing the ventricular size gradually to a near normal FOHR with clinical improvement.