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Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma.doc

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Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma

World Journal of Surgical Oncology BioMedCentral Case report Open Access Duodenoportal fistula caused by peptic ulcer after extended right hepatectomy for hilar cholangiocarcinoma Hiroyuki Kinoshita, Katsunari Takifuji, Yoshihiro Nakatani, Masaji Tani, Kazuhisa Uchiyama and Hiroki Yamaue* Address: Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan Email: Hiroyuki Kinoshita - hry-kinoshita@wakayamah.rofuku.go.jp; Katsunari Takifuji - takifuji@wakayama-med.ac.jp; Yoshihiro Nakatani - nakataniy@mwn.hosp.go.jp; Masaji Tani - matani@wakayama-med.ac.jp; Kazuhisa Uchiyama - kuchi@wakayama- med.ac.jp; Hiroki Yamaue* - yamaue-h@wakayama-med.ac.jp * Corresponding author Published: 24 November 2006 Received: 01 March 2006 Accepted: 24 November 2006 World Journal of Surgical Oncology 2006, 4:84 doi:10.1186/1477-7819-4-84 This article is available from: /content/4/1/84 ? 2006 Kinoshita et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background: A fistula between the duodenum and the main portal vein near a peptic ulcer is extremely rare, and only two cases of duodenal ulcers have been reported in the past. Case presentation: We report a 68-year-old man with a diagnosis of anemia who had a history of extended right hepatectomy for hilar cholangiocarcinoma 20 months previously. The first endoscopic examination revealed a giant peptic ulcer with active bleeding at the posterior wall of the duodenal bulbs, and hemostasis was performed. Endoscopic treatment and transarterial embolization were performed repeatedly because of uncontrollable bleeding from the duodenal ulcer. Nevertheless, he died of sudden massive hema