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- Title
Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices.
- Authors
Ota, Kazuhiro; Okazaki, Masatoshi; Higashihara, Hideyuki; Kokawa, Hiroshi; Shirai, Zentaro; Anan, Akira; Kitamura, Yuji; Shijo, Hiroshi; Ota, K; Okazaki, M; Higashihara, H; Kokawa, H; Shirai, Z; Anan, A; Kitamura, Y; Shijo, H
- Abstract
Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report a 65-year-old woman who presented with hematemesis and melena. She was admitted to our department because of prolonged shock, despite having received transfusion of a large volume of blood. Upper gastrointestinal endoscopy revealed nodular varices with active bleeding in the second portion of the duodenum. Endoscopic injection sclerotherapy (EIS) was performed using a tissue adhesive agent, alpha-cyanoacrylate monomer, with only temporary benefit. However, anemia continued to progress after the procedure. Therefore, we combined transileocolic vein obliteration (TIO) with balloon-occluded retrograde transvenous obliteration (B-RIO), using 5% ethanolamine oleate with iopamidol to obliterate the varices. Complete hemostasis was achieved without complications. Neither recurrence of varices nor further bleeding has occurred for over 3 years. We conclude that combined TIO and B-RTO, which can obstruct both the feeding and the draining vessels of duodenal varices to retain the sclerosing agent completely in the varices, is a safe and effective hemostatic measure for ruptured duodenal varices, when EIS has failed to accomplish complete hemostasis.
- Subjects
VARICOSE veins; DUODENAL diseases; HEMATEMESIS; HEMORRHAGE; SCLEROTHERAPY
- Publication
Journal of Gastroenterology, 1999, Vol 34, Issue 6, p694
- ISSN
0944-1174
- Publication type
journal article
- DOI
10.1007/s005350050321