Duodenal Varix Rupture – A Rare Cause of Fatal Gastrointestinal Hemorrhage: A Case Report and Review of Literature

Iqbal, Sadat; Likhtshteyn, Michelle; O’Brien, D.; McFarlane, Samy I.; Martı́nez, Manuel

doi:10.12691/ajmcr-7-4-3

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…Our initial search yielded 395 case reports of SIV in patients with cirrhosis, of which 76 (19.2%) reported SIV bleeding and were included for collation and analysis (9–20,21–30,31–40,41–50,51–60,61–78). Mean age was 52.4 years (range 40–68), 32 were women, and 44 were men.…”

Section: Resultsmentioning

confidence: 99%

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

et al. 2021

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INTRODUCTION: Esophageal varices are a well-characterized sequela of portal hypertension; however, less is known about varices arising in ectopic locations. We aimed to describe bleeding small intestine varices (SIV) in patients with cirrhosis and compare characteristics and outcomes to published case reports. METHODS: We performed an institutional chart review using billing codes and natural language processing between 2008 and 2019. Inclusion criteria were adult patients with cirrhosis and SIV verified by endoscopy, video capsule, or imaging. Patients with noncirrhotic portal hypertension and stomal varices were excluded. We examined demographic and clinical factors, characteristics of SIV, bleeding, intervention, and outcomes in our series and collated data from published cases identified during a literature review. RESULTS: We identified 71 patients with cirrhosis and SIV (18 bled). The literature search yielded 76 cases with bleeding SIV. Our series and published cases were matched for age, sex, liver disease etiology, and SIV location. Length of stay and transfusion requirements were similar. Aggregate initial treatments (number, hemostasis rate) included medical (n = 7, 57%), endoscopic (n = 48, 56%), interventional radiology (n = 31, 77%), and surgery (n = 8, 87%). Hospital and overall mortality rates were higher in our series (22% and 38%) compared with the published cases (5.3% and 18.4%), respectively (P = 0.02 and P = 0.07). DISCUSSION: A quarter of patients with cirrhosis and SIV experience bleeding, with high transfusion requirements, frequent need for secondary interventions, and high mortality. These findings highlight the need for a multidisciplinary approach and second-line therapeutic modalities in the timely management of bleeding SIV in cirrhosis.

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Section: Resultsmentioning

confidence: 99%

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

et al. 2021

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“…Limited data from case reports and case series has shown that (TIPS) and BRTO effectively achieved hemostasis in patients with bleeding DVs; however, apart from being more invasive, these modalities are often associated with a high risk of precipitating hepatic encephalopathy, notably with TIPS. 19,[23][24][25][26] In addition, both modalities remain limited to hospitals with technical expertise in radiological intervention. Previous studies have demonstrated that surgical procedures are associated with a high rate of rebleeding and mortality for bleeding ectopic varices, particularly in patients with cirrhosis and portal hypertension.…”

Section: Esophageal Varices 13mentioning

confidence: 99%

“…2,25 Medication alone has limited efficacy in cases of duodenal variceal bleeding. 23 Endoscopic banding has been recommended if the diameter of the varix is less than the diameter of the endoscope, and some have reported successful application of bands for ligation of DV, while others have questioned the usage of band ligation based on animal studies, which suggest a higher likelihood of perforation. 3,[27][28][29] A case of fatal rebleeding after band ligation of DV has also been reported.…”

Section: Esophageal Varices 13mentioning

confidence: 99%

Endoscopic Cyanoacrylate Glue Injection for Duodenal Varices—A Single-Center Study

Shafiq

Devarbhavi

Patil

2022

Journal of Digestive Endoscopy

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Aim/Objectives Duodenal varices (DVs), although rare, can present with massive, potentially fatal upper gastrointestinal bleeding; however, there are no randomized trials regarding management of this relatively uncommon presentation. We aim to report our experience with endoscopic cyanoacrylate glue injection in patients with DVs. Materials and Methods We retrospectively evaluated the medical records of all patients with portal hypertension at our center between January 2010 and December 2021. Demographic characteristics along with the etiology, location, and effectiveness of cyanoacrylate glue injection for bleeding DVs were collected and analyzed. Results A total of 5,892 patients with portal hypertension underwent endoscopy during the study period, of whom 41 patients (M:F = 29:12) with mean age of 38 years were noted to have DVs. While extrahepatic portal vein obstruction was the commonest etiology (n = 26), the most common site of DVs was the duodenal bulb (n = 21). Twenty-one (51%) out of these 41 patients presented primarily with DV bleeding and underwent endoscopic cyanoacrylate glue injection with successful hemostasis achieved of the index bleed; however, four of these 21 patients had rebleeding between 2 weeks and 12 months of follow-up requiring repeat endotherapy.. While three patients underwent successful repeat glue injections, one patient had recurrent massive bleedings, not amenable to endotherapy and was subjected to duodenal resection with surgical shunt procedure. Conclusion While the prevalence of DVs in portal hypertension patients was 0.7% (41/5892), DVs accounted for 0.42% (21/4889) of portal hypertension-related bleedings. Endotherapy with cyanoacrylate glue appears to be a safe and cost-effective treatment for acute DV bleeding in a resource-limited setting.

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“…Currently available treatment modalities for bleeding duodenal varices include medications, endoscopic treatments, radiological interventions, and surgical procedures [ 13 – 16 ]. Published evidence from case reports and case series showed that transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) effectively achieved hemostasis in patients with bleeding duodenal varices [ 11 , 17 , 18 ]. However, these therapies are more invasive and associated with a high risk of hepatic encephalopathy [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

“…Surgical modality is rarely performed. Medication alone has limited efficacy in cases of duodenal variceal bleeding [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review

Wan

Liu²,

Wan³

et al. 2020

European Journal of Gastroenterology &Amp; Hepatology

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Duodenal Varix Rupture – A Rare Cause of Fatal Gastrointestinal Hemorrhage: A Case Report and Review of Literature

Cited by 5 publications

References 11 publications

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

Small Intestine Varices in Cirrhosis at a High-Volume Liver Transplant Center: A Retrospective Database Study and Literature Review

Endoscopic Cyanoacrylate Glue Injection for Duodenal Varices—A Single-Center Study

Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review

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