Korean J Gastrointest Endosc.  1999 Apr;19(2):281-286.

Duodenal Variceal Bleeding Treated with a Transjugular Intrahepatic Portosystemic Shunt

• Kim YS
• Kim HG
• Choi W
• Lee DH
• Kim PS
• Kim IH
• Chang JN
• Shin HJ
• Yoo JG
• Kang SG

Abstract

Most cases of upper gastrointestinal bleeding in patients with portal hypertension are caused by esophagogastric varices. Less often, bleeding originates in varices located elsewhere. If ectopic varices are found, the same hemostatic technique tend to be used. However, there is no evidence that such techniques are useful in these cases. Duodenal varices are quite common, although they rarely bleed due to their location deep in the duodenal wall. Consequently, if emergency endoscopy is not conducted, hemorrhage may be wrongfully attributed to coexisting esophagogastric varices in a patient with portal hypertension without active bleeding. Hemorrhage from duodenal varices may be severe and life threatening. We report a patient with portal hypertension and bleeding duodenal varices caused by cirrhosis of the liver. Hemorrhage was subsequently controlled by placement of a transjugular intrahepatic portosystemic shunt. We recommend that in patients with life-threatening hemorrhage from duodenal varices caused by cirrhosis of the liver, transjugular intrahepatic portosystemic shunt (TIPS) be considered in the man-agement.

Keyword

TIPS; Duodenal varix; Portal hypertension

MeSH Terms

Emergencies
Endoscopy
Esophageal and Gastric Varices*
Fibrosis
Hemorrhage
Hemostatic Techniques
Humans
Hypertension, Portal
Liver
Portasystemic Shunt, Surgical*
Varicose Veins