A Case of Bleeding of Choledocho-Jejuno Anastomosis Successfully Treated by Argon Plasma Coagulation

A 64-year-old man with jaundice was diagnosed with pancreatic head cancer (T3N1M0 stage III) , and gastroduodenectomy of pancreaticoduodenoductomy (SSPPD-II-A) was performed. Enhanced computed tomography revealed local recurrence and metastasis in the liver and portal stenosis 6 months after SSPPD-II-A. The patient had melena after 10 months, and he was admitted because of gastrointestinal bleeding, with hemoglobin of 4.5 g/dl. Esophagogastroduodenoscopy and colonoscopy did not reveal other sources of bleeding. Bleeding scintigraphy was performed, which revealed a bleeding source in the afferent loop. He underwent small intestine endoscopy, which showed vasodilation at the choledocho-jejuno anastomosis. We conclude that vasodilation of the choledocho-jejuno anastomosis occurred because of portal hypertension due to portal stenosis caused by tumor local recurrence. We conducted argon plasma coagulation for vasodilation thrice, and melena did not recur until his death.