Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report

Abstract

BackgroundOne of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV) and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time.Case presentationWe report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur.ConclusionBand ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.

An unusual case of Esophageal Varices: “Downhill” type

“…There is a long list of etiologies described in the literature including central venous catheterization [2,6,7], mediastinal fibrosis [8][9][10][11][12][13][14], primary and metastatic mediastinal tumors [3,10,11,[15][16][17][18][19], mediastinal lymphadenopathy secondary to head and neck cancers such as carcinoma of the tongue [20], substernal goiters and thyroid masses [21][22][23], thyroid carcinoma [3,[21][22][23][24][25], lung cancer [3,10,16,[18][19][20]26,27,28], thymoma [3,29], systemic venulitis [30], Behcet's disease [31][32][33][34][35][36], Castleman's disease (angiofollicular lymph node hyperplasia) [4], and as a late complication after correction of congenital heart defect <...>…”

Downhill varices: An uncommon cause of upper gastrointestinal bleeding

“…In this regard, there is a case of SVCS secondary to Behçet's disease in which a partial SCV thrombosis gave rise to DHV. After the first bleeding episode, multiple endoscopic ligation sessions were conducted achieving variceal eradication (14).…”

Bronchial Varices in a Patient with Behçet&apos;s diasese: A Case Report

“…with Behçet's disease. [3][4][5][6][7][8][9] Although the exact mecha- nism of vessel obstruction associated with Behcet's disease is unknown, a complex mechanism involving interactions among T lymphocytes, neutrophils, and antigen-presenting cells has been proposed. 5,10 In addition, a genetic mutation may contribute; 6 no thrombophilic factor is known to be involved.…”