Unusual Sites of Upper Gastrointestinal Variceal Bleeding

Obscure Gastrointestinal Hemorrhage from Mesenteric Varices Diagnosed by Video Capsule Endoscopy

“…It is postulated that obliteration of the coronary-azygous system could increase portal flow through alternative shunts, promote enlargement of existing varices, and precipitate bleeding (1,9,(16)(17)(18). Banding of varices may have a similar effect, as might have occurred in Case 1.…”

“…Cases of bleeding jejunal varices in the literature are predominately associated with portal hypertension, generally due to cirrhosis (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13). Frequently, there is a history of abdominal surgery, with varices closely associated with intra-abdominal adhesions (1,2,(9)(10)(11)(12)(13)(14)(15).…”

“…Frequently, there is a history of abdominal surgery, with varices closely associated with intra-abdominal adhesions (1,2,(9)(10)(11)(12)(13)(14)(15). Causes of small intestinal varices in the absence of portal hypertension include mesenteric vein thrombosis or obstruction (7).…”

“…Bleeding from intestinal varices following sclerotherapy of esophageal varices or esophageal transection has been reported (1,5,9,16,17). It is postulated that obliteration of the coronary-azygous system could increase portal flow through alternative shunts, promote enlargement of existing varices, and precipitate bleeding (1,9,(16)(17)(18).…”

“…Bleeding from intestinal varices usually presents with hematochezia or melena of obscure origin (19-21) but rarely with hematemesis (1,2,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)22). Moncure, et al (12) described six patients with portal hypertension and actively bleeding small intestinal varices who presented with rectal bleeding or melena.…”