Balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration for ruptured duodenal varices after operation for rectal cancer with multiple liver metastasis: report of a case

Takamura, Kazuhito; Miyake, Hidenori; Mori, Hiroki; Terashima, Yasushi; Ando, Tsutomu; Fujii, Masahiko; Tashiro, Seiki; Shimada, Mitsuo

doi:10.2152/jmi.52.212

Cited by 20 publications

(22 citation statements)

References 14 publications

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“…Ectopic varices can be caused by portal hypertension, venous occlusion or thrombosis, familial causes or changes to vascular anatomy secondary to post-surgical adhesions and scarring. 3,9,14 Ectopic varices can also be caused by a combination of liver disease and loco-regional factors, as in two of our cases. The stimulus to angiogenesis at surgical anastamoses or postsurgical adhesions may cause ectopic varices at such sites in patients with portal hypertension.…”

Section: Introductionsupporting

confidence: 52%

Gastrointestinal Haemorrhage Secondary to Ectopic Varices at the Site of Previous Surgery

Zia¹,

Bashir²,

Tait³

2017

Hong Kong J Radiol

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Ectopic varices are uncommon but potentially life-threatening portosystemic venous collaterals. They are high variable and can occur anywhere across the gastrointestinal tract, except for the pathological sites for portoportal or portosystemic varices. Ectopic varices are responsible for 1% to 5% of all gastrointestinal haemorrhage cases, and their bleeding risk is four times that of oesophageal varices. Patients may present acutely with massive upper or lower gastrointestinal bleeding and consequent shock or chronically with anaemia of unknown origin. First-line diagnostic tests include contrast-enhanced computed tomography, gastrointestinal endoscopy, and angiography. Ectopic varices can be an incidental finding on laparotomy and at autopsy. Mortality can be as high as 40% when associated with severe acute haemorrhage. We report three cases of gastrointestinal haemorrhage secondary to ectopic varices at the site of previous surgery.

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Section: Introductionsupporting

confidence: 52%

Gastrointestinal Haemorrhage Secondary to Ectopic Varices at the Site of Previous Surgery

Zia¹,

Bashir²,

Tait³

2017

Hong Kong J Radiol

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“…PTO has been used to treat duodenal varices without any complication (no hepatic encephalopathy and no increase in liver dysfunction). 17,18 PTO may be associated with rebleeding but targets the bleeding vessels to immediately control hemorrhage. We used PTO to immediately control the duodenal varix bleeding and decoyed coils within the targeted vessels without any complications.…”

Section: Discussionmentioning

confidence: 99%

A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration

Lee

Kim

Choi

et al. 2019

Int J Gastrointest Interv

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A B S T R A C TDuodenal varices are ectopic in nature and account for 40% of all ectopic bleeding cases. Ectopic variceal bleeding is rare (1%-5% of all variceal bleeding cases). The three principle approaches used to treat duodenal varices are endoscopic procedures, interventional radiological methods, and surgical interventions. A 59-year-old male with alcoholic liver cirrhosis and chronic hepatitis B infection visited our gastroenterology department with melena. Gastroduodenoscopy and computed tomography identified varices in the second part of the duodenum. We performed percutaneous transhepatic obliteration using glue and coil embolization, which obliterated the varices and resulted in immediate hemostasis. However, 3 months later, he re-visited presenting with newly developed duodenal varices and underwent endoscopic injection sclerotherapy.

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“…If PTO were not effective, we would perform a combination treatment of PTO plus B-RTO. 30 After the PTO treatment, color Doppler ultrasonography was remarkably useful in evaluating therapeutic effect on the duodenal varices.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of color Doppler ultrasonography for the diagnosis of duodenal varices successfully treated with percutaneous transhepatic obliteration

et al. 2007

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We treated a 74-year-old woman who complained of tarry stool. Neither endoscopic examination of the upper gastrointestinal tract nor colonoscopy revealed any finding indicative of bleeding, and (99m)Tc-HSA-D pool scintigraphic imaging showed no accumulation of blood in the digestive tract. Small tortuous collateral veins were observed on computed tomography (CT) in the distal third portion of the duodenum. Color Doppler ultrasonography obtained color flow images of varices in the distal third portion of the duodenum indicating turbulent flow, and color flow imaging showed the outflow vessel from duodenal varices. Duodenoscopy revealed tortuous varices, with erosions and blue in appearance, in the same area. Percutaneous transhepatic portography was carried out 18 days after the treatment of ascites, and hepatofugal blood flow was confirmed in the pancreatic duodenal vein originating near the junction between the splenic and inferior mesenteric veins with the passage of contrast medium into the duodenal varices, which drained into the left ovarian vein. We performed selective catheterization into the afferent vein of the varices, and injected 8 ml of a 5% solution of ethanolamine oleate containing iopamidol. Microcoil embolization using steel coils was added because the therapeutic effect resulting after the relatively rapid washout of sclerosant was insufficient. CT and color Doppler ultrasonography showed absence of blood flow in the varices 1 week after the therapy. This patient has had no episodes of rebleeding in the 24 months after therapy. Color Doppler ultrasonography was useful in diagnosing this case of duodenal varices and in evaluating therapeutic effect.

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Balloon occluded retrograde transvenous obliteration and percutaneous transhepatic obliteration for ruptured duodenal varices after operation for rectal cancer with multiple liver metastasis: report of a case

Cited by 20 publications

References 14 publications

Gastrointestinal Haemorrhage Secondary to Ectopic Varices at the Site of Previous Surgery

Gastrointestinal Haemorrhage Secondary to Ectopic Varices at the Site of Previous Surgery

A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration

Efficacy of color Doppler ultrasonography for the diagnosis of duodenal varices successfully treated with percutaneous transhepatic obliteration

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