Percutaneous transsplenic embolization of jejunal varices in a patient with liver cirrhosis: A case report
Department of Radiology, Hanyang University Hospital, 17 Haengdang-dong, Sungdong-gu, Seoul, 133-792, Korea. Abdominal Imaging
(Impact Factor: 1.63).
04/2012; 38(1). DOI: 10.1007/s00261-012-9894-2
Bleeding jejunal varices are rare and could be life threatening. They are usually found in the presence of portal hypertension and prior history of gastrointestinal surgery. They can be effectively managed by radiological interventions such as transjugular intrahepatic portosystemic shunt or transhepatic embolization of varices. However, in patients with portal vein obstruction, an alternative access is necessary. We report a case of bleeding jejunal varices associated with postoperative adhesion in a patient with portal vein thrombosis which was successfully managed by percutaneous transsplenic embolization.
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ABSTRACT: Acquired portal vein (PV) stenosis or occlusion is most commonly seen after liver transplantation. In the nontransplant population, PV stenosis or occlusion can occur with pancreatitis, tumor encasement, and postsurgical complications. Portal hypertension resulting from PV stenosis or occlusion can cause variceal bleeding in the gastrointestinal tract. Bleeding from ectopic varices, such as duodenum, jejunum, ileum, and rectum, is rare and can be life threatening in patients with portal hypertension. There are several treatment options for the management of PV stenosis or occlusion combined with variceal bleeding such as PV stenting, transjugular intrahepatic portosystemic shunt (TIPS) and transhepatic or transsplenic embolization of varices. Herein we report a case of jejunal variceal bleeding with postoperative PV occlusion successfully managed by PV stent-graft placement and variceal embolization.
Available from: Chen-Shuan Chung
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ABSTRACT: Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.
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