Korean J Hepatol.  2011 Jun;17(2):152-156. 10.3350/kjhep.2011.17.2.152.

Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

• Kang HY
• Lee WK
• Kim YH
• Kwon BW
• Kang MS
• Kim SB
• Song IH

• KMID: 1015575
• DOI: http://doi.org/10.3350/kjhep.2011.17.2.152

Abstract

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.

Keyword

Duodenal varices; Endoscopic injection sclerotherapy; Portal hypertension; Cirrhosis

MeSH Terms

Cyanoacrylates/therapeutic use
Duodenal Diseases/diagnosis/etiology/*therapy
Duodenum/*blood supply
Endoscopy, Gastrointestinal
Gastrointestinal Hemorrhage/etiology/*therapy
Humans
Male
Middle Aged
Portal Vein
Rupture
Sclerosing Solutions/therapeutic use
*Sclerotherapy
Tomography, X-Ray Computed
Varicose Veins/complications/*therapy