Clin Endosc.  2020 Nov;53(6):750-753. 10.5946/ce.2019.167.

Endoscopic Ultrasound-Guided Vascular Therapy for Portoduodenal Fistula

• Chantarojanasiri T
• Sirinawasatien A
• Bunchorntavakul C
• Siripun A
• Treepongkaruna Sa
• Ratanachu-ek T

• KMID: 2511237
• DOI: http://doi.org/10.5946/ce.2019.167

Abstract

Portoenteric fistula is a rare cause of massive upper gastrointestinal bleeding. Most cases can be treated with radiointervention or surgery, but portoenteric fistula is associated with a high mortality. We reported a case of intermittent massive upper gastrointestinal bleeding in a 33-year-old man with cholangiocarcinoma who underwent surgical resection followed by chemoradiation. A portoduodenal fistula due to chronic duodenal ulceration was identified. The bleeding was successfully controlled by endoscopic ultrasound-guided coil placement through the duodenal bulb using the anchoring technique. Follow-up endoscopy and computed tomography scan showed multiple coil placements between a part of the portal vein and the duodenal bulb without any evidence of portal vein thrombosis. There were no complications, and bleeding did not recur during the 8-month follow-up period.

Keyword

Endosonography; Gastrointestinal hemorrhage; Vascular fistula

Figure

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  Fig. 1. Endoscopic view showing active bleeding from an ulcer at the duodenal bulb.

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  Fig. 2. Computed tomography scan showing portal vein (arrow) attached to about the duodenal bulb (arrowhead).

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  Fig. 3. Endoscopic ultrasound (EUS) images showing the portal vein attached to the base of the ulcer (A). EUS-guided coil embolization was performed (B, coil marked with arrowhead). Fluoroscopic image shows the coil placement without migration (C). The fine aspiration needle was withdrawn during coil deployment, leaving the distal part of the coil anchored against the duodenal wall (D).

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  Fig. 4. Follow-up endoscopy showing friable ulcer with a visible coil on the ulcer base.

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  Fig. 5. Follow-up computed tomography scan showing coil embolization at the portoenteric fistula.

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