Successful percutaneous angioembolisation of bleeding jejunal varix by acrylate glue and coils

Abstract

Portal hypertension is a common disease worldwide. One of its rare complications is bleeding jejunal varices which is usually asymptomatic and may present with gastrointestinal bleeding. We present a case of a jejunal bleeding that was successfully embolised with acrylate glue and embolisation coils. A middle-aged woman with a history of multiple abdominal surgeries for adenocarcinoma of right ovary, presented to us with multiple episodes of haematochezia. On a CT scan of the abdomen, she was diagnosed with chronic liver disease with portal hypertension, multiple varices at porto-systemic anastomosis and ectopic jejunal varix. She was treated by interventional radiologists by percutaneous embolisation of bleeding varix using glue and embolisation coils through a portal venous approach.

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

“…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.…”

“…It was notable that 6 of 18 patients with bleeding SIV were treated with medical therapy alone in our series. Four of the 6 died of nonbleeding causes, and had advanced liver disease with high baseline MELD-Na scores (20)(21)(22)(23)(24)(25)(26)(27)(28)(29), while 2 had relatively small volume and self-limited bleeds (total 2-3 units of packed red blood cell transfused) without rebleeding during follow-up. This observation reflects the role of medical therapy as a temporizing measure Figure 3.…”