J Korean Med Sci.  2012 Mar;27(3):321-324. 10.3346/jkms.2012.27.3.321.

Jejunal Variceal Bleeding Successfully Treated with Percutaneous Coil Embolization

Affiliations
  • 1Institute for Digestive Research and Digestive Disease Center, Department of Gastroenterology, Soonchunhyang University Hospital, Seoul, Korea. jeongsw@schmc.ac.kr
  • 2Institute for Digestive Research and Digestive Disease Center, Department of Radiology, Soonchunhyang University Hospital, Seoul, Korea.

Abstract

A 52-yr-old male with alcoholic liver cirrhosis was hospitalized for hematochezia. He had undergone small-bowel resection due to trauma 15 yr previously. Esophagogastroduodenoscopy showed grade 1 esophageal varices without bleeding. No bleeding lesion was seen on colonoscopy, but capsule endoscopy showed suspicious bleeding from angiodysplasia in the small bowel. After 2 weeks of conservative treatment, the hematochezia stopped. However, 1 week later, the patient was re-admitted with hematochezia and a hemoglobin level of 5.5 g/dL. Capsule endoscopy was performed again and showed active bleeding in the mid-jejunum. Abdominal computed tomography revealed a varix in the jejunal branch of the superior mesenteric vein. A direct portogram performed via the transhepatic route showed portosystemic collaterals at the distal jejunum. The patient underwent coil embolization of the superior mesenteric vein just above the portosystemic collaterals and was subsequently discharged without re-bleeding. At 8 months after discharge, his condition has remained stable, without further bleeding episodes.

Keyword

Hematochezia; Capsule Endoscopy; Abdominal Computed Tomography; Jejunal Varices; Embolization

MeSH Terms

Embolization, Therapeutic/*methods
Gastrointestinal Hemorrhage/etiology/therapy
Humans
Jejunum/*blood supply
Liver Cirrhosis, Alcoholic/complications
Male
Middle Aged
Varicose Veins/diagnosis/etiology/*therapy

Figure

  • Fig. 1 Capsule endoscopic findings show blood-stained mucosa below the mid-jejunum, with suspected active bleeding (arrow) of a jejunal varix.

  • Fig. 2 Jejunal varices and main portal vein in multidetector CT; Axial scan and multiplanar reformation in multidetector CT show multiple and dilated jejunal varices (arrow). Note the main portal vein (small arrows) in the multiplanar reformation.

  • Fig. 3 Serial direct portogram and coil embolization; Serial direct portogram shows hepatofugal flow into the superior mesenteric vein and multiple dilated portosystemic shunts from the superior mesenteric vein to both internal iliac veins (A-D). Coil embolization of the superior mesenteric vein was performed just above the portosystemic shunts (E).


Cited by  2 articles

Surgical Removal of Migrated Coil after Embolization of Jejunal Variceal Bleeding: A Case Report
Junhwan Kim, Danbi Lee, Kyunghwan Oh, Mingee Lee, Seol So, Dong-Hoon Yang, Chan-Wook Kim, Dong Il Gwon, Young-Hwa Chung
Korean J Gastroenterol. 2017;69(1):74-78.    doi: 10.4166/kjg.2017.69.1.74.

Mucosal Changes in the Small Intestines in Portal Hypertension: First Study Using the Pillcam SB3 Capsule Endoscopy System
Mahesh Kumar Goenka, Bhavik Bharat Shah, Vijay Kumar Rai, Surabhi Jajodia, Usha Goenka
Clin Endosc. 2018;51(6):563-569.    doi: 10.5946/ce.2018.041.


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