Korean J Gastroenterol.  2015 Nov;66(5):286-290. 10.4166/kjg.2015.66.5.286.

Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization

Affiliations
  • 1Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea. miunorijw@hallym.or.kr
  • 2Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea.

Abstract

Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.

Keyword

Duodenum; Varicose vein; Embolization

MeSH Terms

Aged
Duodenum
Embolization, Therapeutic
Endoscopy, Gastrointestinal
Esophageal and Gastric Varices/complications/*diagnosis
Gastrointestinal Hemorrhage/*therapy
Humans
Liver Cirrhosis/complications/*diagnosis
Male
Portal Vein/diagnostic imaging
*Portasystemic Shunt, Transjugular Intrahepatic
Recurrence
Tomography, X-Ray Computed

Figure

  • Fig. 1. (A) Upper gastroduodenoscopy shows a varix in the second portion of duodenum, with red spot. (B) Endo-scopic photograph shows the successfully band-ligated duodenal varix.

  • Fig. 2. (A) On later endoscopy, post ligation ulceration was observed without bleeding sign. (B) There was no blood clot or trace of bleeding in other part of duodenum.

  • Fig. 3. In the third portion of the duodenum, multiple dilated varices (arrow) were detected on contrast enhanced CT angiography.

  • Fig. 4. (A) Under ultrasonographic and fluoroscopic guidance, transsplenic approach to the portal vein and duodenal varix (arrow) was done. (B) Selective and complete embolization of duodenal varix with glue was done using microcatheter.


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Korean J Gastroenterol. 2020;76(6):331-336.    doi: 10.4166/kjg.2020.123.

Successful Transjugular Intrahepatic Portosystemic Shunt with Embolization Subsequent to Endoscopic Variceal Band Ligation for Bleeding Anorectal Varices
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Korean J Gastroenterol. 2018;71(4):234-238.    doi: 10.4166/kjg.2018.71.4.234.


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