Ectopic duodenal variceal bleed successfully treated with TIPS and 2 years follow-up: A Case Report

Abstract

Duodenal varices are an uncommon presentation of portal hypertension and can result in significant gastrointestinal bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. We present a case of upper gastrointestinal bleeding in a woman aged 54 years with primary biliary cholangitis who was ultimately diagnosed with ectopic duodenal variceal bleed, which was successfully treated with transjugular intrahepatic portosystemic shunt. Transjugular intrahepatic portosystemic shunt provide an effective treatment for ectopic duodenal variceal bleed caused by liver cirrhosis, though interventional radiologists need to remain aware of and vigilant for the complications and risks of this treatment option.

Massive duodenal variceal hemorrhage in a patient with prior Roux-en-Y gastric bypass

“…Mengying Liu et al reported a case of 54-year-old female with duodenal variceal bleed, primary biliary cirrhosis and Child-Pugh class B who was treated with TIPS and venous embolization together. The patient had no rebleeding or residual duodenal varix at 24 months follow up [3] . In our case, the patient was treated with percutaneous transhepatic embolization followed by TIPS due to initial contraindication, but still had favorable outcomes.…”

“…About 50% of patients with cirrhosis develop varices in gastroesophageal region whereas only 3.5%-8.5% have varices develop elsewhere in the gastrointestinal (GI) tract. These are known as ectopic varices [ 1 , 2 , 3 ]. Variceal bleeding occurs in 25%-35% of patients with cirrhosis with mortality of up to 30% [4] .…”

“…Due to its rarity, there is a relative lack of evidence for effective treatments for ectopic varices. Current treatment methods include medical management, surgical interventions, endoscopic band ligation, endoscopic sclerotherapy, percutaneous transhepatic embolization, and transjugular intrahepatic portosystemic shunt (TIPS) with varied outcomes [ 3 , 7 ]. We present the imaging findings of a patient with duodenal variceal hemorrhage in a patient with history of Roux-en-Y gastric bypass (RYGB) which was successfully treated with percutaneous transhepatic embolization followed by TIPS.…”

Afferent vein embolization via retrograde approach as a potential treatment strategy for bleeding duodenal varices

“…They discuss gastroesophageal variceal bleeding mainly. A few case reports report favorable outcomes of TIPS for duodenal varices [ 6 , 7 ]. However, in a coherent report that described ectopic varices, including duodenal varices [8] , 25% of patients after TIPS had re-rupture.…”

A Case Report on Duodenal Variceal Bleeding Treated with Glue Injection

“…The prevalence of duodenal varices is associated with the cause of portal hypertension and the technique used to display the varices; up to 40% of patients with portal hypertension undergoing angiography showed duodenal varices. Although the frequency of bleeding is low, when it does bleed, it can be fatal with a mortality of 35% to 40% [1]. The most common cause (30%) of duodenal varices is portal hypertension due to liver cirrhosis.…”