Jejunal Varix with Extrahepatic Portal Obstruction Treated by Embolization Using Interventional Radiology: Report of a Case

Abstract

We report a case of relapsing jejunal varix with extrahepatic portal obstruction, which was successfully treated by embolization using interventional radiology. A 79-year-old woman suffered repeated episodes of tarry stools 2 years after undergoing jejunal resection for a jejunal varix. The bleeding point was inferred to be in the small intestine, and abdominal angiography revealed extrahepatic portal obstruction and the development of a jejunal varix around the hepaticojejunostomy. Because surgical obliteration of the varices or a shunt operation for portal decompression may have been very invasive due to severe adhesions, the jejunal varix was embolized with anhydrous ethanol and interlocking detachable coils. There were no changes in liver enzymes, the clearance rate of indocyanine green, or portal pressure, and there has been no sign of rebleeding for 13 months. Our experience shows that hemostasis can last, as long as the embolization can be done without aggravating portal hypertension. In conclusion, embolization using interventional radiology is a safe and useful method of treating intestinal varices.

Obscure Gastrointestinal Hemorrhage from Mesenteric Varices Diagnosed by Video Capsule Endoscopy

“…Cases of bleeding jejunal varices in the literature are predominately associated with portal hypertension, generally due to cirrhosis (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13). Frequently, there is a history of abdominal surgery, with varices closely associated with intra-abdominal adhesions (1,2,(9)(10)(11)(12)(13)(14)(15).…”

Tratamento de hemorragia intestinal grave decorrente de hipertensão porta, por meio de esplenectomia subtotal e anastomose esplenorrenal proximal

“…A formação de varizes no intestino delgado tem a mesma fisiopatologia, porém não se acompanha de complicações 5,7,10,[26][27][28][29][30] . Embora não esteja claro o motivo pelo qual varizes sangram, postula-se que aderências intra-abdominais em torno de áreas operadas sejam vias hepatofugas, elevando ainda mais a pressão local 5,10,[26][27][28][29][30][31][32] . A acurácia dos testes diagnósticos para detectar varizes sangrantes do intestino delgado é baixa.…”

“…Outros exames, como a cintilografia com hemácias marcadas com tecnécio 99m, têm uma sensibilidade de apenas 48 % 36 . Já a arteriografia, que é o procedimento diagnóstico mais utilizado para detectar sangramento de intestino delgado, é capaz de indicar o sangramento somente se o exame for feito no momento da hemorragia e ela for superior a 1 ml/min 7,10,26,27,29,32,37,38,39 . Mesmo nessas condições, o diagnóstico pode ser feito com segurança em menos de 75 % dos casos 37 .…”

Stent placement is effective on both postoperative hepatic arterial pseudoaneurysm and subsequent portal vein stricture: A case report

“…Jejunal varices caused by portal venous obliteration could be treated with either a shunt for portal decompression [10,11] , an angioplasty by an IVR technique such as balloon dilation, stenting to correct the portal blood flow [12] or embolizing varices by an IVR technique to stop inflow [13,14] . Making a treatment choice is complex, involving various factors such as portal hemodynamics, the extent of liver fibrosis, and the cause of portal venous obliteration.…”