Korean J Gastroenterol.  2023 Dec;82(6):304-309. 10.4166/kjg.2023.116.

Small Bowel Variceal Bleeding in Patients with Liver Cirrhosis Treated with Transarterial Embolization: Case Series

• Seo B
• Lee JH
• Jang EJ
• Park SW
• Park JS
• Park SJ
• Kim SJ
• Yeon JW
• Lee AY
• Seo Jy

• KMID: 2549815
• DOI: http://doi.org/10.4166/kjg.2023.116

Abstract

Small bowel variceal bleeding is a rare cause of gastrointestinal hemorrhage, with clinical manifestations ranging from asymptomatic incidental findings to life-threatening conditions. The diagnosis and management of small bowel bleeding are challenging because of the localization of the lesion and the difficulty of the procedure. Trans-arterial embolization (TAE) is a secure and straightforward method for treating ectopic varices. On the other hand, there have been limited local studies on the outcomes of TAE for patients with small bowel variceal hemorrhage. This paper reports patients diagnosed with small bowel variceal bleeding and treated with TAE.

Keyword

Gastrointestinal hemorrhage; Embolization; Therapeutic

Figure

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  Fig. 1 Computed tomographic Images of small bowel varix. (A) Tortuous dilated small bowel varix with partial thrombi in duodenal second portion in patient 1. (B) small bowel varix with protrusion into ileal lumen in patient 2. (C) Prominent encircling varix at the jejunal loop in patient 3.

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  Fig. 2 Angiographic images of small bowel varix treated with trans-arterial embolization. (A) Small bowel varix with partial thrombi in duodenal second portion in patient 1. (B) Small bowel varix between SMV and left inferior epigastric vein in patient 2. (C) Small bowel varix at the jejunal loop in patient 3. (D) Embolization using microcoils was performed in patient 1. (E) Embolization using microcoils, cyanoacrylate, and gelfoam was performed in patient 2. (F) Embolization using microcoils and cyanoacrylate was performed in patient 3. SMV, superior mesenteric vein.

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  Fig. 3 (A) Endoscopic image of varix with a red color sign at the duodenal second portion in patient 1. (B) Initial hemostasis using endoscopic band ligation was performed.

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  Fig. 4 Capsule endoscopy of the active arterial bleeding from small bowel varix in patient 2.

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