• Meisheng Li, Qinghan Li, Qiucheng Lei, Jianyuan Hu, Fengjie Wang, Huanwei Chen, and Zuojun Zhen.
• Department of Hepatopancreatic Surgery, The First People's Hospital of Foshan, the Affiliated Foshan Hospital of Sun Yat-Sen University, Guangdong, China.
• Medicine (Baltimore). 2018 Aug 1; 97 (32): e11784.

RationaleEctopic variceal bleeding due to hepaticojejunostomy (HJ) is unusual and difficult to manage. Reports on the use of side-to-side splenorenal shunt for severe bleeding from varices at HJ anastomosis are lacking.Patient ConcernsA 43-year-old man was admitted to our hospital with repeated episodes of hematemesis. He has a history of right hemihepatectomy with HJ reconstruction to the left hepatic duct for hilar cholangiocarcinoma. Two years after surgery, he presented with repeated episodes of hematemesis and underwent blood transfusion.DiagnosesImaging tests and endoscopic investigation failed to identify the bleeding source. When conservative management failed to control his bleeding, he underwent emergency laparotomy, which revealed hemorrhage from ectopic varices at the HJ anastomosis.InterventionsTo arrest the bleeding, a side-to-side venovenal anastomosis was created between the splenic and left renal veins to form a shunt for decompression of the varices at the HJ anastomosis.OutcomesAfter the surgery, the patient's symptoms ceased, and a no bleeding in the digestive tract was noted at 2-year follow-up.LessonsThe present patient is the first reported case of unusual bleeding from HJ controlled by a side-to-side splenorenal shunt. We believe this approach is a useful and effective surgical treatment for severe bleeding from varices at the HJ anastomosis.

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