Conservative Management for Postoperative Portal Vein Bleeding: A Case Report

A 73-year-old man underwent radical surgery for hilar cholangiocarcinoma. Complications included portal vein thrombosis on postoperative day 7 and anastomotic bile leakage. On postoperative day 33, massive bloody output (900 mL/day) occurred from a surgical drain. Contrast injection through a replaced drainage catheter revealed a main portal vein perforation at the site of the drain contact via the drain tract. Following conservative management by catheter clamping, computed tomography showed an abscess spilling into the portal vein through the perforation. Percutaneous transhepatic biliary drainage was performed for external drainage to prevent further influx. The patient recovered and was discharged on postoperative day 58. Portal vein bleeding should be recognized as a source of postoperative hemorrhage following pancreatobiliary surgery. Conservative management targeting spontaneous tract thrombosis may be a viable treatment option.