A case of endoscopie injection sclerotherapy for a bleeding duodenal varix

Tsuji, Hideaki; Okano, Hitoshi; Fujino, Hiroya; Satoh, Tatsuyuki; Kodama, Tadashi; Takino, Tatsuro; Yoshimura, Norio; Aikawa, Ichiro; Oka, Takahiro; Tsuchihashi, Yasunari

doi:10.1007/bf02774872

Cited by 19 publications

(10 citation statements)

References 7 publications

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“…Endoscopic treatment is one of the most reasonable options, as it can provide diagnosis as well as the potential for less invasive intervention and treatment in the form of sclerotherapy and ligation 15. However, the efficacy of endoscopic variceal ligation is short-term and limited to small varices, and endoscopic injection sclerotherapy appears to be less effective against duodenal varices and also has a risk of perforation after the procedure 1 16 17. TIPS is a means of effectively treating acute variceal haemorrhage in patients refractory to endoscopic treatment, and in patients whose gastrointestinal varices are difficult to access by endovascular intervention, or who are poor surgical candidates 1 9.…”

Section: Discussionmentioning

confidence: 99%

Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension

et al. 2013

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SUMMARYDuodenal varices are an unexpected source of upper gastrointestinal haemorrhage associated with high mortality. The prevalence of ectopic variceal bleeding accounts for 2-5% of all variceal bleeding; of this, only 17% occurs in the duodenum. Diagnosis is difficult, and insufficient evidence exists to demonstrate the best treatment option when haemorrhage occurs. We report the case of a 69-year-old man with a history of chronic alcoholism who presented to the emergency department (ED) with nausea, vomiting and several episodes of haematochezia. Diagnostic workup in the ED included CT with multiplanar reconstruction, which revealed a network of large tortuous blood vessels running near the second portion of the duodenum between the inferior vena cava and portal vein. The patient was emergently treated with endoscopic therapy and clipping of the vessel. This failed, and he was subsequently taken to the operating room for suture ligation of the bleeding duodenal varices. BACKGROUND

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Section: Discussionmentioning

confidence: 99%

Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension

et al. 2013

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“…However, the efficacy of EVL is of short term and limited to small varices [8]. EIS has a risk of perforation after the procedure [9]. TIPS has been widely preformed, especially in patients with gastrointestinal varices which are difficult to access by endovascular intervention procedure.…”

Section: Discussionmentioning

confidence: 99%

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

et al. 2010

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Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a fourchannel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multidetector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

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“…Therefore, it appears that EIS is a useful first-line treatment for bleeding duodenal varices. 6,[20][21][22][23] Because our patient was in poor physical condition and in profound shock on admission, and because her family requested relatively noninvasive treatment, we elected to perform EIS. Ethanolamine oleate (EO) is superior to polidocanol (Kreussler, Wiesbaden, Germany) which is common sclerosing agent same as EO, for devascularizing collateral vessels; 24 however, EO may induce hemorrhage because repeated applications are often necessary.…”

Section: Discussionmentioning

confidence: 99%

“…Total serum protein level was 7.1 g/dl (NR, 6.7-8.3) and serum albumin was 2.5 g/dl Offprint requests to: K. Ota (Received July 9, 1997, accepted Nov. 28,1997) (NR, 4.0-5.0). Other pertinent laboratory data included total bilirubin, 0.6 mg/dl (NR, 0.3-1.2); aspartate aminotransferase, 160 IU/l (NR, 33Ͼ); alanine aminotransaminase, 102 IU/l (NR, 35Ͼ); cholinesterase, 53 IU/l (NR, 220-470); urea nitrogen, 14 mg/dl (NR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]; creatinine, 1 mg/dl (NR, 0.6-1.1); prothrombin time, 11.9 s (NR, [10][11][12][13]; and indocyanine green retention rate at 15 min stationary, elevated to 21.8% (NR, Ͻ10). Hepatitis B surface (HBs) antigen was negative, but hepatitis C virus (HCV) antibody test was positive.…”

Section: Case Reportmentioning

confidence: 99%

Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices

Shirai

Masuzaki

et al. 1998

Journal of Gastroenterology

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Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 77-year-old woman with cirrhosis who presented with melena. She was admitted to our Department because of prolonged shock although she had received a large blood transfusion. Upper gastrointestinal endoscopy revealed nodular varices in the third portion of the duodenum which were considered to be the source of the bleeding. Endoscopic injection sclerotherapy (EIS) with n-butyl-2-cyanoacrylate (Histoacryl; Braun-Melsungen, Germany), an adhesive agent, was performed. We injected 1.5 ml of Histoacryl with Lipiodol (Laboratoire-Guerbet, France) intravariceally and achieved successful hemostasis. This patient's duodenal varices had almost completely resolved 1 month after EIS. We conclude that EIS with Histoacryl is an effective hemostatic measure for ruptured duodenal varices.

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A case of endoscopie injection sclerotherapy for a bleeding duodenal varix

Cited by 19 publications

References 7 publications

Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension

Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices

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