A Case of Massive Bleeding Duodenal Varices Successfully Controlled with Transjugular Intrahepatic Portosystemic Shung

Yoon, Young Joon; Hahn, Kwang Hyub; Lee, So Yun; Paik, Yong Han; Chung, Jae Yeon; Kim, Chul; Chon, Chae Yoon; Moon, Young Myoung

Abstract

Duodenal varices can be resulted from either liver cirrhosis or extrahepatic portal hypertension. Bleeding from duodenal varices is rare but often severe and life threatening. Bleeding of duodenal varices can be treated with non-surgical or surgical treatment. Non-surgical treatments include endoscopic variceal ligation, endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Surgical treatments include shunt surgery, variceal ligation, variceal resection, and duodenectomy. However, endoscopic treatments are not so effective and surgical interventions have many limitations. A 68-year-old man with liver cirrhosis was admitted to our department and presented with mental change and melena. He received a large amount of transfusion and it was not possible to perform gastrointestinal endoscopy. Emergency angiography revealed marked dilatation of mesenteric veins, which was treated by TIPS. After TIPS, transfusion requirement was markedly reduced and gastrointestinal endoscopy demonstrated duodenal varices without bleeding. We conclude that TIPS may be an effective therapeutic option for control of hemorrhage from duodenal varices.