Korean J Gastroenterol.  2018 Jul;72(1):37-41. 10.4166/kjg.2018.72.1.37.

Ascending Colon Variceal Bleeding in Cirrhotic Patient with Emergent Endoscopic Variceal Obturation with N-butyl-2-cyanoacrylate

• Kim CL
• Kim T
• Lee WH
• Seo JW
• Park SH
• Choi JH
• Heo NY

• KMID: 2416935
• DOI: http://doi.org/10.4166/kjg.2018.72.1.37

Abstract

Ectopic varices are rare among patients with portal hypertension, especially in the ascending colon. It is difficult to evaluate massive lower gastrointestinal bleeding in patients with liver cirrhosis by colonoscopy due to hemodynamic instability and poor bowel preparation. In Korea, there has only been one case report about ascending colon variceal bleeding, in which hemostasis was performed by venous coil embolization. We report another rare case of ascending colon variceal bleeding in a patient with alcoholic cirrhosis, who was successfully treated via two sessions of N-butyl-2-cyanoacrylate injection through colonoscopy. This case suggests that the careful endoscopic approach and hemostasis with glue injection might be an option for treating massive bleeding in the lower gastrointestinal varix.

Keyword

Colon, ascending; Colonoscopy; Cyanoacrylates; Liver cirrhosis; Varix

MeSH Terms

Adhesives
Colon, Ascending*
Colonoscopy
Cyanoacrylates
Embolization, Therapeutic
Enbucrilate*
Esophageal and Gastric Varices*
Hemodynamics
Hemorrhage
Hemostasis
Humans
Hypertension, Portal
Korea
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Varicose Veins
Adhesives
Cyanoacrylates
Enbucrilate

Figure

• 

  Fig. 1. At proximal ascending colon, there was dilated vascular structure with shallow erosion (A). The endoscopic variceal obturation with N-butyl-2-acyanoacrylate was performed through colonoscopy (B).

• 

  Fig. 2. Second session of endoscopic variceal obturation was done targeting the remnant dilated varix one week after 1st session (A). After 2nd injection, bloated varix with sclerosant was noted (B).

• 

  Fig. 3. Simple abdomen after 2nd endoscopic variceal obturation (white arrow: lipiodol in the ascending colon varix).

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  Fig. 4. A radiopague lipiodol attenuation with N-butyl-2-cyanoacrylate in the ascending varix was shown after hemostatic procedure (white arrow). The liver shows surface nodularity and blunting edge.

Reference

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