Korean J Gastroenterol.  2014 Apr;63(4):248-252. 10.4166/kjg.2014.63.4.248.

Long-term Successful Treatment of Massive Distal Duodenal Variceal Bleeding with Balloon-occluded Retrograde Transvenous Obliteration

• Hwang SW
• Sohn JH
• Kim TY
• Kim JY
• Yhi J
• Kwak DS
• Kim HS
• Song SY

• KMID: 1791883
• DOI: http://doi.org/10.4166/kjg.2014.63.4.248

Abstract

Duodenal variceal bleeding in patients with portal hypertension due to cirrhosis or other causes is uncommon. We report on a case of a 55-year-old male with an ectopic variceal rupture at the distal fourth part of the duodenum who presented with massive hematochezia and shock. Shortly after achievement of hemodynamic stability, due to the limitation of an endoscopic procedure, we initially attempted to find the bleeding focus by abdominal computed tomography, which showed tortuous duodenal varices that drained into the left gonadal vein. He was treated with first-line balloon-occluded retrograde transvenous obliteration (BRTO), resulting in a favorable long-term outcome without rebleeding three years later. This case suggests that BRTO may be a first-line therapeutic option for control of ruptured duodenal varices, especially at a distal location.

Keyword

Bleeding, duodenal; Varix, ectopic; Cirrhosis; Treatment; Balloon occlusion

MeSH Terms

Balloon Occlusion
Duodenal Diseases/*diagnosis/radiography/therapy
Embolization, Therapeutic
Gastrointestinal Hemorrhage/therapy
Humans
Male
Middle Aged
Tomography, X-Ray Computed

Figure

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  Fig. 1. (A) Axial images of a portal- phase abdominal CT scan show varices (arrow) of the fourth part of the duodenum. (B) These duodenal varices (v) drained into the left renal vein (rv) through the left gonadal vein (gv).

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  Fig. 2. (A) Radiograph obtained after infusion of a mixture of a sclerotic agent and lipiodol through a micro-catheter (white arrow) during balloon occlusion (black arrow) shows duodenal varices and the afferent vein (asterisks). (B) Axial image of a portal phased abdominal CT shows filling of the sclerosant within duodenal varices by the sclerosant (arrow).

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  Fig. 3. (A) Two weeks after the balloon-occluded retrograde transvenous obliteration procedure, gastroduodenoscopy showed small esophageal varices at the lower esophagus. (B) Push enteroscopy showed ruptured erosion (arrow) on the varix at the fourth part of the duodenum.

Reference

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