J Korean Soc Radiol.  2020 Jan;81(1):231-236. 10.3348/jksr.2020.81.1.231.

Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report

• Park SJ
• Kim YH
• Kang UR
• Ji SW

• KMID: 2469199
• DOI: http://doi.org/10.3348/jksr.2020.81.1.231

Abstract

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

MeSH Terms

Duodenum
Embolization, Therapeutic
Endoscopy
Esophageal and Gastric Varices*
Hemorrhage
Humans
Hypertension, Portal
Liver Cirrhosis
Portasystemic Shunt, Surgical
Varicose Veins

Figure

• 

  Fig. 1. A 50-year-old woman with massive hematemesis. A. Endoscopy shows active bleeding from the duodenal varix (arrow). B. Axial contrast-enhanced computed tomography demonstrates a varix in the 3rd portion of the duodenum (white arrow) supplied by the inferior pancreaticoduodenal vein and draining into the right ovarian vein to form the mesocaval shunt (black arrow). C. Coronal contrast-enhanced computed tomography shows the mesocaval shunt formed by the inferior pancreaticoduodenal (white arrow) and right ovarian (black arrow) veins. D. Coil-assisted retrograde transvenous obliteration was successfully performed using a double microcatheter technique. Detachable coils were deployed in the ovarian vein through a more proximally placed microcatheter (arrow). E. Gelfoam mixed with a contrast agent was injected to embolize the duodenal varices (black arrow) and inferior pancreaticoduodenal vein (white arrow). F. Axial contrast-enhanced computed tomography obtained 6 months after coil-assisted retrograde transvenous obliteration shows complete obliteration of the duodenal varices (arrow).

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