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Kim HW, Yoon JS, Yu SJ, Kim TH, Seol JH, Kim D, Jung JY, Jeong PH, Kwon H, Lee HS, Lee SH, Choi JS, Park SJ, Jee SR, Lee YJ, Seol SY. Percutaneous Trans-splenic Obliteration for Duodenal Variceal bleeding: A Case Report. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2020; 76:331-336. [PMID: 33361709 DOI: 10.4166/kjg.2020.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 06/12/2023]
Abstract
Duodenal varices are a serious complication of portal hypertension. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). The patient no longer complained of melena after treatment. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding.
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Affiliation(s)
- Hyun Woo Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jun Sik Yoon
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Seung Jung Yu
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Tae Heon Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jae Heon Seol
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Dan Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jun Young Jung
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Pyeong Hwa Jeong
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Hoon Kwon
- Department of Radiology, Pusan National University Hospital, Busan, Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sang Heon Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Jung Sik Choi
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sung Jae Park
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sam Ryong Jee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Youn Jae Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
| | - Sang Yong Seol
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Kore
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Abstract
PURPOSE OF REVIEW The objective is to provide an overview on the cause of small bowel bleeding. We discuss the role of small bowel endoscopy in the management of small bowel bleeding and provide an outline of pharmacotherapy that can be additionally beneficial. RECENT FINDINGS Small bowel capsule endoscopy (SBCE) is the initial diagnostic investigation of choice in small bowel bleeding. Computed tomography (CT) can be helpful in the context of small bowel tumours. Device-assisted enteroscopy (DAE) enables several therapeutic procedures such as argon plasma coagulation (APC) and haemoclip application. It can also guide further management with histology or by marking culprit lesions with India ink. A persistent rate of rebleeding despite APC is increasingly being reported. Pharmacotherapy has an emerging role in the management of small bowel bleeding. Somatostatin analogues are a well tolerated class of drugs that can play an additional role in the management of refractory bleeding secondary to small bowel angioectasias. SUMMARY SBCE is useful in determining the cause of small bowel bleeding. DAE offers an endoscopic therapeutic approach to small bowel bleeding replacing surgery and intraoperative enteroscopy. Pharmacotherapy, in addition to endotherapy, can play an important role in the management of multifocal, recurring bleeding small bowel lesions.
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Park SW, Jun CH, Choi SK, Kim HS, Park CH, Rew JS, Park SY, Cho E, Kim JK, Kim HO. Successful Transjugular Intrahepatic Portosystemic Shunt with Embolization Subsequent to Endoscopic Variceal Band Ligation for Bleeding Anorectal Varices. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2018; 71:234-238. [PMID: 29684973 DOI: 10.4166/kjg.2018.71.4.234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Anorectal variceal bleeding is a rare occurrence; however, in such event, it could be fatal due to large size and high blood flow rate of varices. However, to date, there is no standardized treatment modality. Although endoscopic treatment can be provided, in cases of recurrent anorectal variceal bleeding, other therapeutic modalities for hemostasis are necessary. Here, we present a case of 58-year-old female patient with liver cirrhosis, who suffered from massive bleeding of anorectal varices. Endoscopic variceal band ligation was performed for primary hemostasis. Additionally, transjugular intrahepatic portosystemic shunt (TIPS) with embolization was performed to reduce the risk of rebleeding. Following the procedure, she had no further bleeding episodes, and the size of anorectal varices decreased, as seen on an abdomino-pelvic computed tomography. Our case illustrates the effectiveness of combined radiological intervention of TIPS with embolization after endoscopic hemostasis, for variceal obliteration and prevention of rebleeding.
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Affiliation(s)
- Sang Woo Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Chung Hwan Jun
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Kyu Choi
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Soo Kim
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Chang Hwan Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Sun Rew
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seon Young Park
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Eunae Cho
- Division of Gastroenterology, Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Kyu Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyoung Ook Kim
- Department of Radiology, Chonnam National University Medical School, Gwangju, Korea
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