An unusual cause of upper gastrointestinal system bleeding: Duodenal varices

Duodenal varisler, portal hipertansiyonu olan hastalarda nadir fakat ciddi ve ölümcül bir kanamanedenidir. Üst gastrointestinal kanama ile gelen karaciğer sirozu olan 27 yaşında bir erkek hastayısunduk. Üst gastrointestinal sistem endoskopisinde, kanama kaynağının duodenum ikincikısımdaki nodüler varisden olduğunu gördük. Biz adheziv bir ajan olan N-butyl-2-cyanoacrylate(Histoacryl) enjekte ettik ve başarılı bir hemostaz sağladık. Histoacryl ile endoskopik enjeksiyonskleroterapisinin kanayan duodenal varisler için etkili bir tedavi seçeneği olduğuna inanıyoruz.

Üst gastrointestinal sistem kanamasının nadir bir nedeni: Duodenal varisler

Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, buttheir rupture is a serious and often fatal event. We report the case of a 27-year-old man with livercirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopyrevealed nodular varices in the second portion of the duodenum which were considered to be thesource of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent,and achieved successful hemostasis. We conclude that endoscopic injection sclerotherapy (EIS)with Histoacryl is an effective treatment option for ruptured duodenal varices.

PDF

___

1. Akazawa Y, Murata I, Yamao T, Yamakawa M, Kawano Y, Nomura N, Isomoto H, Mizuta Y, Murase K, Kohno S. Successful management of bleeding duodenal varices by endoscopic variceal ligation and balloon-occluded retrograde transvenous obliteration. Gastrointest Endosc 2003; 58: 794-7.
2. Ota K, Shirai Z, Masuzaki T, Tanaka K, Higashihara H, Okazaki M, Arakawa M. Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices. J Gastroenterol 1998; 33: 550-5.
3. Ota K, Okazaki M, Higashihara H, Kokawa H, Shirai Z, Anan A, Kitamura Y, Shijo H. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices. J Gastroenterol 1999; 34: 694-9.
4. Tsurusaki M, Sugimoto K, Matsumoto S, Izaki K, Fukuda T, Akasaka Y, Fujii M, Hirota S, Sugimura K. Bleeding Duodenal Varices Successfully Treated with Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO) Assisted by CT During Arterial Portography. Cardiovasc Intervent Radiol 2006; 29: 1148-51.
5. McAlister VC, Al-Saleh NA. Duodenal dearterialization and stapling for severe hemorrhage from duodenal varices with portal vein thrombosis. Am J Surg 2005; 189: 49-52.
6. Sonomura T, Horihata K, Yamahara K, Dozaiku T, Toyonaga T, Hiroka T, Sato M. Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration: usefulness of microcatheters. AJR Am J Roentgenol 2003; 181: 725-7.
7. Bosch A, Marsano L, Varilek GW. Successful obliteration of duodenal varices after endoscopic ligation. Dig Dis Sci 2003; 48: 1809-12.
8. Machida T, Sato K, Kojima A, Takezawa J, Sohara N, Kakizaki S, Takagi H, Mori M. Ruptured duodenal varices after endoscopic ligation of esophageal varices: an autopsy case. Gastrointest Endosc 2006; 63: 352-4.
9. D'Imperio N, Piemontese A, Baroncini D, Billi P, Borioni D, Dal Monte PP, Borrello P. Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy 1996; 28: 239-43.
10. Zargar SA, Javid G, Khan BA, Yattoo GN, Shah AH, Gulzar GM, Singh J, Rehman BU, Din Z. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002; 36: 666-72.