Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

Abstract

Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a fourchannel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multidetector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

Multidetector computed tomography three-dimensional and multiplanar reconstruction diagnosis of a rare cause of gastrointestinal bleeding: A case report

“…Few reports have suggested the importance of MPR in the diagnosis of ectopic varices[ 16 , 17 ]. The usefulness of multidetector helical CT with multiplanar reconstruction for depicting duodenal varices with multiple collateral shunt vessels has been reported[ 6 ]. CT-MIP is a clinically useful modality to distinguish gastric varices from ectopic varices[ 18 ].…”

“…However, traditional endoscopy cannot reach the distal portion of the duodenum, and angiography sometimes fails to show duodenal varicose veins[ 4 ]. Recently, there have been reports of multidetector computed tomography (CT) with multiplanar reconstruction (MPR) for the diagnosis and therapeutic management of duodenal varices[ 5 , 6 ]. Our case suggests the usefulness of multidetector CT with MPR combined with three-dimensional (3D) images for the diagnosis and therapeutic management of duodenal varices.…”

A case report of bleeding from a duodenal varix: Rare cause of upper gastrointestinal bleeding

“…CT angiography is another useful diagnostic modality to detect duodenal varices [ 11 ]. In recent reports, multislices helical CT scans with multiplanar reconstruction, in addition to endoscopy, aid in the diagnosis and management of duodenal varices [ 14 , 15 ]. In our case, we were misled by the initial finding of the D1 duodenal ulcer.…”

Fatal upper gastrointestinal bleed arising from duodenal varices secondary to undiagnosed portal hypertension

“…A CT angiography also has been reported as efficient in detecting duodenal varices 5. The multislice helical CT has also been shown to be effective in depicting duodenal varices as a cause of massive upper gastrointestinal bleeding, along with recent reports of the effectiveness of the multidetector helical CT with multiplanar reconstruction, suggesting that this may play an increasingly important role in the detection of ectopic intestinal varices in patients with cirrhosis and gastrointestinal bleeding 13 14…”