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

• Koo SM
• Jeong SW
• Jang JY
• Lee TH
• Jeon SR
• Kim HG
• Kim JO
• Kim YJ

• KMID: 1793006
• DOI: http://doi.org/10.3346/jkms.2012.27.3.321

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.

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  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.

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  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).

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