Bleeding ileal varicosity demonstrated by transhepatic portography

Kinkhabwala, Mahesh; Mousavi, Azam Sadat; Iyer, Sneha; Adamsons, R J

doi:10.2214/ajr.129.3.514

Cited by 78 publications

(53 citation statements)

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“…IAN D. NORTON, 1 JAMES C. ANDREWS, 2 AND PATRICK S. KAMATH 1 The term ''ectopic varices'' is sometimes reserved for abnormally dilated veins associated with gastrointestinal mucosa and, therefore, with the potential for gastrointestinal hemorrhage. However, the term has also been used loosely to describe portosystemic collateral veins in the abdominal wall and retroperitoneum.…”

Section: Management Of Ectopic Varicesmentioning

confidence: 99%

“…1,3 Ectopic varices are a relatively common finding at endoscopy in patients with portal hypertension. The prevalence seems to be related to the cause of the portal hypertension and the technique used to show the varices.…”

Section: Prevalencementioning

confidence: 99%

“…1 The clinician caring for patients with gastrointestinal bleeding must be aware of this entity, because diagnosis and management of ectopic varices differ from that of esophagogastric varices. Furthermore, the prognosis from bleeding ectopic varices may be poor, with one study quoting 40% mortality at initial bleed from duodenal varices.…”

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confidence: 99%

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Management of ectopic varices

1998

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The term ''ectopic varices'' is sometimes reserved for abnormally dilated veins associated with gastrointestinal mucosa and, therefore, with the potential for gastrointestinal hemorrhage. However, the term has also been used loosely to describe portosystemic collateral veins in the abdominal wall and retroperitoneum. The distinction between ''ectopic varices'' and collaterals that are commonly found on the abdominal wall and retroperitoneum of patients with portal hypertension is one of semantics. Thus, ectopic varices may be best defined as large portosystemic venous collaterals occurring anywhere in the abdomen except in the cardioesophageal region.Ectopic varices are an unusual cause of gastrointestinal hemorrhage, but account for up to 5% of all variceal bleeding. 1 The clinician caring for patients with gastrointestinal bleeding must be aware of this entity, because diagnosis and management of ectopic varices differ from that of esophagogastric varices. Furthermore, the prognosis from bleeding ectopic varices may be poor, with one study quoting 40% mortality at initial bleed from duodenal varices. 2 The literature on this subject consists mainly of small series and case reports with no randomized trials of therapeutic modalities. However, a review of the literature does provide sufficient information from which rational management decisions can be made. PREVALENCEEctopic varices account for between 1% and 5% of all variceal bleeding. 1,3 Ectopic varices are a relatively common finding at endoscopy in patients with portal hypertension. The prevalence seems to be related to the cause of the portal hypertension and the technique used to show the varices. In patients with intrahepatic portal hypertension, duodenal varices are seen in 40% of patients undergoing angiography, 3 whereas anorectal varices have been reported in between 10% and 40% of cirrhotic patients undergoing colonoscopy. 4,5 It is important to differentiate anal varices from hemorrhoids: Anal varices collapse with digital pressure, whereas hemorrhoids do not. 4 In patients with portal hypertension caused by obstruction of the portal or splenic veins, duodenal varices are more prevalent than in patients with intrahepatic portal hypertension. The prevalence is higher if angiography is used to show varices. In fact, most patients with portal or splenic vein thrombosis are likely to have duodenal varices shown on angiography. 6,7 The majority of patients with duodenal varices visualized on endoscopy have extrahepatic portal hypertension. In contrast to duodenal varices, it appears that most cases of varices in other portions of the small intestine and colonic varices are seen in patients with intrahepatic portal hypertension who have previously undergone abdominal surgery. 6 In the west, because the prevalence of extrahepatic portal hypertension is low, most bleeding from ectopic varices is usually associated with intrahepatic portal hypertension. 6,8 Stomal varices are a particularly common cause of ectopic varices and occur in patients with intrah...

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Section: Management Of Ectopic Varicesmentioning

confidence: 99%

Section: Prevalencementioning

confidence: 99%

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Management of ectopic varices

1998

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“…Ectopic varices are common findings during endoscopy in portal hypertensive patients. Bleeding ectopic varices are a rare cause of variceal bleeding and accounts for only 1-5% of all variceal bleeding [48]. Ectopic varices occur in anorectum, antrum (IGV2), and duodenum, small intestine, colon, and peristomal.…”

Section: Diagnosis and Treatment Of Acute Ectopic Variceal Bleedingmentioning

confidence: 99%

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

et al. 2011

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Background Acute variceal bleeding (AVB) is a medical emergency and associated with a mortality of 20% at 6 weeks. Significant advances have occurred in the recent past and hence there is a need to update the existing consensus guidelines. There is also a need to include the literature from the Eastern and Asian countries where majority of patients with portal hypertension (PHT) live. MethodsThe expert working party, predominantly from the Asia-Pacific region, reviewed the existing literature and deliberated to develop consensus guidelines. The working party adopted the Oxford system for developing an evidence-based approach. Only those statements that were unanimously approved by the experts were accepted. Results AVB is defined as a bleed in a known or suspected case of PHT, with the presence of hematemesis within 24 h of presentation, and/or ongoing melena, with last melanic stool within last 24 h. The time frame for the 123Hepatol Int (2011( ) 5:607-624 DOI 10.1007 AVB episode is 48 h. AVB is further classified as active or inactive at the time of endoscopy. Combination therapy with vasoactive drugs (\30 min of hospitalization) and endoscopic variceal ligation (door to scope time \6 h) is accepted as first-line therapy. Rebleeding (48 h of T 0 ) is further sub-classified as very early rebleeding (48 to 120 h from T 0 ), early rebleeding (6 to 42 days from T 0 ) and late rebleeding (after 42 days from T 0 ) to maintain uniformity in clinical trials. Emphasis should be to evaluate the role of adjusted blood requirement index (ABRI), assessment of associated comorbid conditions and poor predictors of nonresponse to combination therapy, and proposed APASL (Asian Pacific Association for Study of the Liver) Severity Score in assessing these patients. Role of hepatic venous pressure gradient in AVB is considered useful. Antibiotic (cephalosporins) prophylaxis is recommended and search for acute ischemic hepatic injury should be done. New guidelines have been developed for management of variceal bleed in patients with non-cirrhotic PHT and variceal bleed in pediatric patients. Conclusion Management of acute variceal bleeding in Asia-Pacific region needs special attention for uniformity of treatment and future clinical trials.

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“…Ectopic varices are an unusual cause of gastrointestinal hemorrhage that account for up to 5% of all variceal bleeding [3, 4]. Among bleeding episodes, those related to duodenal varices can be severe, as these latter are often more difficult to sclerose than esophageal varices.…”

Section: Introductionmentioning

confidence: 99%

Association of Transjugular Intrahepatic Portosystemic Shunt with Embolization in the Treatment of Bleeding Duodenal Varix Refractory to Sclerotherapy

et al. 2000

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Background: Bleeding from duodenal varices are often severe (mortality as high as 40%), and more difficult to sclerose than esophageal varices. We report a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement and varix embolization, via the same transjugular intrahepatic route. Methods: A 40-year-old Black male underwent emergency TIPS and duodenal varix embolization after failure of endoscopic sclerotherapy. The portosystemic pressure gradient droped from 16 to 9 mm Hg following TIPS. At 5 months from TIPS, the patient is well, with a patent shunt at Doppler ultrasound. Conclusion: The present report of successful control of duodenal varix, actively bleeding and refractory to sclerotherapy, by means of combined TIPS and embolization, supports the role of TIPS and suggests that its association to embolization can be valuably considered in the difficult setting of portal hypertension with bleeding duodenal varices.

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Bleeding ileal varicosity demonstrated by transhepatic portography

Cited by 78 publications

References 2 publications

Management of ectopic varices

Management of ectopic varices

Diagnosis and management of acute variceal bleeding: Asian Pacific Association for Study of the Liver recommendations

Association of Transjugular Intrahepatic Portosystemic Shunt with Embolization in the Treatment of Bleeding Duodenal Varix Refractory to Sclerotherapy

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