2.Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization.
So My KOO ; Soung Won JEONG ; Jae Young JANG ; Tae Hee LEE ; Seong Ran JEON ; Hyun Gun KIM ; Jin Oh KIM ; Yong Jae KIM
Journal of Korean Medical Science 2012;27(3):321-324
A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment, the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes.
Embolization, Therapeutic/*methods
;
Gastrointestinal Hemorrhage/etiology/therapy
;
Humans
;
Jejunum/*blood supply
;
Liver Cirrhosis, Alcoholic/complications
;
Male
;
Middle Aged
;
Varicose Veins/diagnosis/etiology/*therapy
3.Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report.
Ha Yan KANG ; Won Kyung LEE ; Yong Hyun KIM ; Byung Woon KWON ; Myung Soo KANG ; Suk Bae KIM ; Il Han SONG
The Korean Journal of Hepatology 2011;17(2):152-156
Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.
Cyanoacrylates/therapeutic use
;
Duodenal Diseases/diagnosis/etiology/*therapy
;
Duodenum/*blood supply
;
Endoscopy, Gastrointestinal
;
Gastrointestinal Hemorrhage/etiology/*therapy
;
Humans
;
Male
;
Middle Aged
;
Portal Vein
;
Rupture
;
Sclerosing Solutions/therapeutic use
;
*Sclerotherapy
;
Tomography, X-Ray Computed
;
Varicose Veins/complications/*therapy