Minimally invasive surgery for obscure idiopathic ileal varices diagnosed by capsule endoscopy and double balloon endoscopy: report of a case

Konishi, Hirotaka; Kikuchi, Shojiro; Miyashita, Atsushi; Ichikawa, Daisuke; Fujiwara, Hitoshi; Kubota, Takeshi; Ochiai, Toshiya; Kokuba, Yukihito; Yasukawa, Satoshi; Yanagisawa, Akio; Otsuji, Eigo

doi:10.1007/s00595-009-4180-9

Cited by 10 publications

(8 citation statements)

References 20 publications

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“…Other methods, such as surgery and endoscopic sclerotherapy, have also been reported for the treatment of ectopic varices. 10,14 In our patient, severe intraabdominal adhesion was an obstacle to the use of these methods. Recent reports described the efficacy of balloon-occluded retrograde transvenous obliteration (BRTO) and PTS.…”

Section: Discussionmentioning

confidence: 73%

“…Furthermore, TIPS is also associated with a high mortality rate in patients with severe liver dysfunction despite a functioning shunt. Other methods, such as surgery and endoscopic sclerotherapy, have also been reported for the treatment of ectopic varices . In our patient, severe intra‐abdominal adhesion was an obstacle to the use of these methods.…”

Section: Discussionmentioning

confidence: 78%

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Percutaneous transhepatic sclerotherapy for recurrent bleeding ileal varices diagnosed by capsule endoscopy and computed tomography during percutaneous transhepatic venography

Hashimoto

Amano

Fukumoto

et al. 2013

Hepatology Research

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We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver cirrhosis. A 64-year-old man was admitted to our hospital for further investigation of blood in stools. Preliminary examination by computed tomography (CT) as well as upper and lower endoscopy could not detect the bleeding source. Exploratory laparotomy was considered difficult due to potential easy bleeding and adhesions caused by past abdominal surgery. The hemoglobin level was normalized by blood transfusion. Capsule endoscopy (CE) identified ileal varices. The top of these ileal varices was red, prompting their identification as the source of bleeding. Percutaneous transhepatic venography (PTV) confirmed the presence of many varices in the branch of the superior mesenteric vein, although the bleeding source could not be identified. CT during PTV identified varices protruding into the ileal lumen, which were managed subsequently by percutaneous transhepatic sclerotherapy (PTS). The procedure stopped the bleeding completely. CE proved less invasive and effective in detecting obscure gastrointestinal bleeding. CT during PTV followed by PTS is suitable for diagnosis and treatment of bleeding varices in patients with portal hypertension.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 78%

Percutaneous transhepatic sclerotherapy for recurrent bleeding ileal varices diagnosed by capsule endoscopy and computed tomography during percutaneous transhepatic venography

Hashimoto

Amano

Fukumoto

et al. 2013

Hepatology Research

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“…Furthermore, approximately 42.9% of patients experience re-bleeding after endoscopic hemostasis; thus, the most effective approach for stopping bleeding is surgical intervention [ 4 ]. The goal of surgery is to remove the bowel segment containing the lesion, but definitively localizing the AGD can be problematic [ 1 , 5 – 7 ]. Good localizability is a good indication for laparoscopic surgery, which has spread remarkably in Japan; however, the anatomy of the small intestine makes detection of jejunal lesions difficult.…”

Section: Discussionmentioning

confidence: 99%

Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia: a case report

et al. 2020

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Background Angiodysplasia of the gastrointestinal tract is a rare vascular pathology that sometimes causes massive hemorrhage. Angiodysplasias are particularly difficult to find in the small intestine for anatomical reasons, often impeding their diagnosis and treatment. Lesion localization is a major challenge in cases of small bowel bleeding requiring surgical intervention. Case presentation The present case was a 52-year-old woman who was urgently hospitalized with repeated tarry stools. Surgical intervention was chosen after conservative treatment failed to improve her condition. The source of bleeding was suspected to be a vascular lesion discovered in the small intestine during a past double-balloon endoscopy. Abdominal contrast computed tomography revealed a jejunal hemorrhage. We chose selective arterial embolization to stabilize her hemodynamics followed by surgical intervention as her treatment plan. Several embolic and contrast agents (cyanoacrylate, indigo carmine, and Lipiodol) were combined to help identify the location of the lesion during surgery. This multi-pronged approach allowed us to localize the lesion under laparoscopic guidance with high confidence and accuracy, and to excise a 6-cm segment of the small intestine. The lesion was histologically diagnosed as angiodysplasia. No re-bleeding has been observed since the operation. Conclusion We report our experience with a case of jejunal angiodysplasia, which was localized with selective arterial embolization using an array of embolic and contrast agents, and then excised laparoscopically. Selective arterial embolization with indigo carmine dye to treat small bowel bleeding preoperatively not only makes the surgery safer by stabilizing the patient’s hemodynamics, but is also very useful for localizing the lesion intraoperatively.

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“…Surgical resection was performed in 76.1% (16/21) of all patients. Some recent patients underwent interventional radiology (IVR) treatment methods such as transjugular intrahepatic portosystemic shunt (TIPS)[ 8 - 10 ] and balloon-occluded retrograde transvenous obliteration (BRTO)[ 11 , 12 ].…”

Section: Discussionmentioning

confidence: 99%

Ectopic gastrointestinal variceal bleeding with portal hypertension

Minowa

Komatsu

Takashina

et al. 2017

WJGS

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Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we report a case of ectopic ileal variceal bleeding in a 57-year-old woman, which was successfully diagnosed by multi-detector row CT (MDCT) and angiography and treated by segmental ileum resection. To date, there have been no consensus for the treatment of ectopic ileal variceal bleeding. This review was designed to clarify the clinical characteristics of patients with ectopic ileal variceal and discuss possible treatment strategies. From the PubMed database and our own database, we reviewed 21 consecutive cases of ileal variceal bleeding diagnosed from 1982 to 2017. MDCT and angiography is useful for the rapid examination and surgical resection of an affected lesion and is a safe and effective treatment strategy to avoid further bleeding.

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Minimally invasive surgery for obscure idiopathic ileal varices diagnosed by capsule endoscopy and double balloon endoscopy: report of a case

Cited by 10 publications

References 20 publications

Percutaneous transhepatic sclerotherapy for recurrent bleeding ileal varices diagnosed by capsule endoscopy and computed tomography during percutaneous transhepatic venography

Percutaneous transhepatic sclerotherapy for recurrent bleeding ileal varices diagnosed by capsule endoscopy and computed tomography during percutaneous transhepatic venography

Successful laparoscopic surgery combined with selective arterial embolization for bleeding due to jejunal angiodysplasia: a case report

Ectopic gastrointestinal variceal bleeding with portal hypertension

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