Jejunal varices diagnosed by capsule endoscopy in patients with post‐liver transplant portal hypertension

Abstract

Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant.

Recurrent Ectopic Variceal Bleed After Pancreas Transplantation With No Portal Hypertension: Case Report and Outcomes of Endovascular Onyx Embolization

“…Ectopic variceal bleed is seen in 1% to 5% in cirrhosis, 7 27% to 40% in extrahepatic portal hypertension, and up to 64% in coexisting portal venous occlusion and hepatobiliary surgery. 8 Bass et al 9 reported jejunal variceal bleed in pediatric cases after liver transplant with portal thrombosis. Hyun et al 10 reported delayed jejunal variceal bleed at hepaticojejunostomy or choledochojejunostomy anastomosis in the setting of portal venous occlusion.…”

Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

“…57 When endoscopic evaluation fails identify a source of upper or lower gastrointestinal bleeding, capsule endoscopy can aid in diagnosis and localization of ectopic small bowel varices for endovascular intervention. 58 Additional diagnostic imaging considerations include a conventional CT venous phase and percutaneous transhepatic portography. 59 Often, endoscopic management is not possible due to distal location when medical management fails.…”