Korean J Gastroenterol.  2023 Dec;82(6):295-299. 10.4166/kjg.2023.105.

Plug-Assisted Retrograde Transvenous Obliteration for the Treatment of Duodenal Variceal Bleeding - A Case Report and Literature Review

• Lee KK
• Park JY
• Choi WS
• Cho YY

• KMID: 2549813
• DOI: http://doi.org/10.4166/kjg.2023.105

Abstract

Duodenal varices are uncommon complications of portal hypertension. Although duodenal variceal bleeding is infrequent, it is a life-threatening condition with a high mortality rate. Non-surgical methods for duodenal variceal bleeding include endoscopic band ligation, endoscopic sclerotherapy, transjugular intrahepatic portosystemic shunt, and retrograde transvenous obliteration. On the other hand, an optimal treatment strategy for this rare condition has not been established. A 38-year-old male with a history of alcoholic liver cirrhosis presented with hematemesis. An emergency esophagogastroduodenoscopy (EGD) revealed large, multiple varices in the second portion of the duodenum, and plug-assisted retrograde transvenous obliteration (PARTO) was performed accordingly. Gastrointestinal bleeding was resolved after the procedure. Follow-up EGD conducted after 11 weeks revealed complete obliteration of the previously observed duodenal varices. PARTO may be considered a viable option for treating duodenal variceal bleeding.

Keyword

Duodenum; Varix; Gastrointestinal hemorrhage; Embolization; therapeutic

Figure

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  Fig. 1 Esophagogastroduodenoscopy revealed multiple tortuous varices accompanied by erosion with active bleeding in the second portion of the duodenum.

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  Fig. 2 Abdominopelvic CT revealed a porto-duodenal shunt (arrow) draining from the superior mesenteric vein into the inferior vena cava.

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  Fig. 3 Angiography performed during intervention. (A) Venography confirmed that the flow from the duodenal varix was directed toward the inferior vena cava (black arrow). (B) A 4 Fr catheter (white arrow) was inserted, and a vascular plug (black arrow) was installed at the shunt inlet to block it. (C) Gel foam was then injected into the duodenal varix (black arrow) through a 4 Fr catheter until the superior mesenteric vein became visible (white arrow).

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  Fig. 4 In the follow-up abdominopelvic CT, the vascular plug (arrow) was confirmed, and successful embolization of the previously dilated duodenal varix was observed.

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  Fig. 5 After an 11-week follow-up, an improved duodenal varix without active bleeding was observed on esophagogastroduodenoscopy.

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