Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case

Abstract

We report a case of successful embolization of jejunal varices that were the cause of massive gastrointestinal bleeding from a choledochojejunostomy site, resulting from obstruction of the extrahepatic portal vein. A 42-year-old man who had undergone choledochojejunostomy for intrahepatic and choledochal stones was readmitted after he started passing massive dark bloody stools. Gastrointestinal endoscopic examination and angiography could not identify the source of bleeding. Percutaneous transhepatic portography showed obstruction of the right branches of the portal vein. The formation of jejunal varices at the site of choledochojejunostomy was revealed by portography and by cholangioscopy, suggesting the varices as the cause of massive bleeding. Bleeding could not be controlled long-term by cholangioscopic sclerosing therapy. We finally stopped the bleeding by embolizing a jejunal vein to the afferent loop.

Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization

“…The treatment of jejunal varices includes surgery (5, 6), transjugular intrahepatic porto-systemic shunt (TIPS) (7, 8), enteroscopic sclerotherapy (9), percutaneous embolization (8, 10-12), and dilatation of a stenosed portal vein followed by stent placement (4, 13). Treatment for segmental varices in which there is superior mesenteric vein stricture without portal hypertension involves surgical resection.…”

“…Non-surgical treatment options include porto-caval shunt (7, 8), endoscopic sclerotherapy (9), embolization (8, 10-12), and balloon dilatation and stent placement in the portal vein for extrahepatic portal venous obstruction (4, 13). …”

Bleeding complications after pancreatic surgery: interventional radiology management

“…The two main options available are the treatment of the jejunal varices themselves or the decompression of the portal system via a trans-jugular portosystemic shunt; the choice between them generally depends on the clinical status of the patient. Direct treatment of the varices include their embolization via an endovascular approach or direct puncture technique, PV angioplasty and stenting, or both (94,(97)(98)(99)(100) and jejunal varices occurred, on average, 27 months after surgery (92). Therefore, it is not always easy to correlate the two events and the diagnosis may be delayed until massive gastrointestinal bleeding from ectopic varix occurs (99).…”

Clinicopathological Features and Treatment of Ectopic Varices with Portal Hypertension

“…A triad of portal hypertension, hematochezia without hematemesis, and previous abdominal surgery characterizes small intestinal varices [69]. Several approaches for the treatment of jejunal varices include surgery [55], portal venous stenting [56, 58, 59], and percutaneous embolization [54, 57]. Surgical approaches such as segmental resection and ligation generally control bleeding from ileal varices successfully [64, 65, 70, 71].…”