ABSTRACT
Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.
Subject(s)
Humans , Male , Middle Aged , Cyanoacrylates/therapeutic use , Duodenal Diseases/diagnosis , Duodenum/blood supply , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/etiology , Portal Vein , Rupture , Sclerosing Solutions/therapeutic use , Sclerotherapy , Tomography, X-Ray Computed , Varicose Veins/complicationsABSTRACT
Duodenal variceal bleeding is rare and difficult to diagnose. The rupture of duodenal varices leads to massive and often fatal bleeding. However, there is currently no definitive conservative therapy for duodenal varices, such as the methods used for treating esophageal and gastric varices. Endoscopic treatment of variceal hemorrhage has been implemented as an initial single, minimally invasive method for treatment. However, this approach has limited success in the treatment of duodenal variceal hemorrhage. We report two cases of massive duodenal variceal bleeding successfully controlled with endoscopic injection sclerotherapy.
Subject(s)
Esophageal and Gastric Varices , Hemorrhage , Rupture , Sclerotherapy , Varicose VeinsABSTRACT
Duodenal varix is a rare cause of hemorrhage in patients with portal hypertension, however their rupture is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic procedures, surgery, or interventional radiologic procedures. We report a case of duodenal varices rupture in a 45-year-old man with alcoholic liver cirrhosis who presented with melena and dizziness. Emergent upper endoscopy revealed large nodular varices with a ruptured erosion on the top in the distal second portion of duodenum. Two consecutive injections with 1.0 mL of n-butyl-2-cyanoacrylate (Histoacryl; Braun-Melsungen, Germany) mixed with 1.0 mL of lipiodol (Laboratoire-Guerbet, France) were performed intravariceally and achieved successful hemostasis. This suggests that endoscopic injection sclerotherapy with histoacryl may be an effective therapeutic option for the control of ruptured duodenal variceal bleeding.
Subject(s)
Humans , Male , Middle Aged , Duodenal Diseases/etiology , Duodenoscopy , Duodenum/blood supply , Enbucrilate/analogs & derivatives , Gastrointestinal Hemorrhage/etiology , Liver Cirrhosis, Alcoholic/complications , Rupture , Sclerosing Solutions/therapeutic use , Sclerotherapy , Tissue Adhesives/therapeutic use , Tomography, X-Ray Computed , Varicose Veins/complicationsABSTRACT
Bleeding duodenal varices are a rare complication in patients with portal hypertension. Cirrhosis followed by portal vein obstruction and splenic vein obstruction are the most common causes. Although the prognosis of bleeding duodenal varices is usually poor, an awareness of its characteristic presentation may enable diagnostic and therapeutic proce- dures to be performed rapidly with an increased likelihood of a reaching successful out- come. In this study, we report a case of bleeding duodenal varices in a 23-year-old woman with idiopathic portal hypertension who was also suffering with recurrent melena. Panendoscopy identified prominant tortuous varices with central erosion in the 3rd portion of the duodenum and no esophageal and gastric varices. The varices were successfully treated by distal splenorenal shunt.
Subject(s)
Female , Humans , Young Adult , Duodenum , Esophageal and Gastric Varices , Fibrosis , Hemorrhage , Hypertension, Portal , Melena , Portal Vein , Prognosis , Splenic Vein , Splenorenal Shunt, Surgical , Varicose VeinsABSTRACT
The bleeding duodenal varices are a rare complication in patients with portal hypertension, but present a difficult diagnostic problem. If there is no bleeding esophageal, gastric fundal varices or ulcer in a patient with upper gastrointestinal bleeding and portal hypertension, the possibility of bleeding duodenal varices should be kept in mind. Thorough endoscopic examination of the entire duodenal mucosa is essential to document bleeding from duodenal varices. As an initial treatment, endoscopic sclerotherapy has had limited success in controlling active duodenal variceal bleeding. However, rebleeding rate is high, surgical treatment including shunt operation may be required for permanent control of bleeding and portal decompression. We report three cases of duodenal varices causing massive hemorrhage. All the patients had portal hypertension caused by liver cirrhosis of various etiologies and had varices in their esophagus. The second portion of the duodenum was the site of duodenal varices in all cases. The management was tailored to the condition of each patient, but only one patient among three survived.