Duodenal and jejunal varices due to superior mesenteric vein thrombosis presenting as a massive gastrointestinal tract bleeding: a case report

Abstract

<jats:title>Abstract</jats:title><jats:p>Duodenal and jejunal varices usually occur due to portal hypertension and are rare causes of gastrointestinal tract bleeding. We report the case of a patient with no clinically significant history of a coagulopathy disorder, cirrhosis, or portal hypertension who presented with duodenal and jejunal varices that resulted in lower gastrointestinal bleeding with superior mesenteric vein thrombosis. Mesenteric angiography revealed superior mesenteric vein thrombosis and varices at the fourth part of the duodenum and the proximal jejunum draining into the main portal vein, but no active bleeding source was recognized. The patient was hemodynamically unstable. Emergency laparotomy was performed and revealed duodenal and jejunal varices, with occlusion of the superior mesenteric vein. Partial resection of the duodenum and jejunum and end-to-end anastomosis were performed. After surgery, the patient was hemodynamically stable with no recurrence of bleeding.</jats:p>

Small bowel varices secondary to chronic superior mesenteric vein thrombosis in a patient with heterozygous Factor V Leiden mutation: a case report

“…Other less common etiologies include: familial varices, adhesions from prior surgery, pancreatic tumors and mesenteric vein thrombosis [ 6 ]. There are only 15 documented cases in the literature reporting small bowel varices secondary to SMV thrombosis, of which three are caused by inherited coagulopathies [ 2 , 7 , 8 ]. Although there is a clear link between inherited thrombophilia and small bowel varices, our case report is the first to describe SMV thrombosis in the context of a ‘heterozygous’ Factor V Leiden mutation.…”

Várices yeyunales secundarias a trombosis de la vena mesentérica superior: una causa inusual de sangrado del intestino delgado

“…Las VID en nuestro paciente, fueron secundarias a la trombosis crónica aislada de la VMS. En la literatura, se han descrito pocos casos de VID secundarias a trombosis aislada de esta vena (4)(5)(6)(7) . Las etiologías de la trombosis venosa reportadas incluyen coagulopatías como deficiencia de las proteínas C, S y antitrombina III, mutación del factor V de Leiden.…”

“…Sin embargo, existen otras etiologías menos frecuentes como el antecedente quirúrgico abdominal, patologías inflamatorias crónicas y la trombosis de la vena mesentérica superior (VMS) (1,2) . Las várices del intestino delgado (VID) secundarias a trombosis aislada de la VMS son muy infrecuentes, se han documentado menos de 25 casos en la literatura (4)(5)(6)(7) , por lo que la evidencia de las posibles intervenciones terapéuticas se reserva a lo descrito en reportes y series de casos (3) . Representan un reto diagnóstico y terapéutico debido la baja prevalencia descrita, la insuficiencia de datos clínicos que orienten a sospecharlas (en contraste con los pacientes con factores de riesgo para hipertensión portal), y la limitada evidencia de las modalidades terapéuticas.…”