Korean J Gastrointest Endosc.  2002 Sep;25(3):153-157.

A Case of Successful Endoscopic Injection Sclerotherapy with N-butyl-2-cyanoacrylate for Bleeding Duodenal Varices Misdiagnosed Initially

• Baek JY
• Chae HS
• Kim HR
• Kwok SK
• Chang JH
• Cho BS
• Lee YJ
• Lee BI
• Cho YS
• Kim SS
• Han SW
• Lee CD
• Choi KY
• Chung IS

Abstract

Duodenal varices are a rare site of hemorrhage in patients with intrahepatic and extrahepatic portal hypertension, but their bleeding is life-threatening complication. Diagnosis of duodenal varices may be difficult, requiring careful inspection of the duodenal bulb during endoscopy. Diagnosis of duodenal varices may also be revealed using angiography and transhepatic portography. Treatment of duodenal varices include endoscopic injection sclerotherapy (EIS), endoscopic variceal ligation (EVL), surgical procedures, and interventional radiology. A 50-year-old woman with liver cirrhosis was admitted with melena and hematochezia. An endoscopy on admission showed esophageal and fundal varices without any bleeding stigma. Colonoscopy showed moderate amount of fresh blood in the terminal ileum. 99mTc-labelled RBC scan showed a suspicion of a distal jejunal bleeding. She had explo-laparotomy of small bowel segmental resection based on 99mTc-labelled RBC but rebleeding occured. Selective mesenteric angiography failed to reveal the source of bleeding. Repeat endoscopy revealed undetected duodenal varix which was covered with fresh blood clots. Endoscopic injection sclerotherapy with n-butyl-2-cyano acrylate (Histoacryl) was performed and achieved succesful hemostasis.

Keyword

Duodenal varix bleeding; Endoscopic injection sclerotherapy; Histoacryl

MeSH Terms

Angiography
Colonoscopy
Diagnosis
Enbucrilate*
Endoscopy
Female
Gastrointestinal Hemorrhage
Hemorrhage*
Hemostasis
Humans
Hypertension, Portal
Ileum
Ligation
Liver Cirrhosis
Melena
Middle Aged
Portography
Radiology, Interventional
Sclerotherapy*
Varicose Veins*
Enbucrilate