Clin Mol Hepatol.  2013 Mar;19(1):78-81. 10.3350/cmh.2013.19.1.78.

A case of variceal bleeding from the jejunum in liver cirrhosis

• Park CW
• Kim SH
• Yang HW
• Lee YJ
• Jung SH
• Song HS
• Lee SO
• Kim A
• Cha SW

• KMID: 1493578
• DOI: http://doi.org/10.3350/cmh.2013.19.1.78

Abstract

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.

Keyword

Jejunal varices; Liver cirrhosis; Portal hypertension

MeSH Terms

Angiography
Capsule Endoscopy
Embolization, Therapeutic
Esophageal and Gastric Varices/complications/diagnosis
Female
*Gastrointestinal Hemorrhage
Humans
Hypertension, Portal
Jejunal Diseases/*diagnosis/therapy
Liver Cirrhosis/*diagnosis
Melena/complications
Middle Aged
Tomography, X-Ray Computed