Journal of Gastroenterology

, Volume 34, Issue 6, pp 694–699

Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices

Authors

  • Kazuhiro Ota
    • Department of Emergency and Critical Care Medicine, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
  • Masatoshi Okazaki
    • Department of Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan
  • Hideyuki Higashihara
    • Department of Radiology, School of Medicine, Fukuoka University, Fukuoka, Japan
  • Hiroshi Kokawa
    • Department of Emergency and Critical Care Medicine, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
  • Zentaro Shirai
    • Department of Emergency and Critical Care Medicine, School of Medicine, Fukuoka University, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
  • Akira Anan
    • First Department of Internal Medicine, School of Medicine, Fukuoka University, Fukuoka, Japan
  • Yuji Kitamura
    • First Department of Internal Medicine, School of Medicine, Fukuoka University, Fukuoka, Japan
  • Hiroshi Shijo
    • First Department of Internal Medicine, School of Medicine, Fukuoka University, Fukuoka, Japan
Case report

DOI: 10.1007/s005350050321

Cite this article as:
Ota, K., Okazaki, M., Higashihara, H. et al. J Gastroenterol (1999) 34: 694. doi:10.1007/s005350050321

Abstract:

Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report a 65-year-old woman who presented with hematemesis and melena. She was admitted to our department because of prolonged shock, despite having received transfusion of a large volume of blood. Upper gastrointestinal endoscopy revealed nodular varices with active bleeding in the second portion of the duodenum. Endoscopic injection sclerotherapy (EIS) was performed using a tissue adhesive agent, α-cyanoacrylate monomer, with only temporary benefit. However, anemia continued to progress after the procedure. Therefore, we combined transileocolic vein obliteration (TIO) with balloon-occluded retrograde transvenous obliteration (B-RIO), using 5% ethanolamine oleate with iopamidol to obliterate the varices. Complete hemostasis was achieved without complications. Neither recurrence of varices nor further bleeding has occurred for over 3 years. We conclude that combined TIO and B-RTO, which can obstruct both the feeding and the draining vessels of duodenal varices to retain the sclerosing agent completely in the varices, is a safe and effective hemostatic measure for ruptured duodenal varices, when EIS has failed to accomplish complete hemostasis.

Key words: duodenal varicescombined therapytransileocolic vein obliterationballoon-occluded retrograde transvenous obliteration

Copyright information

© Springer-Verlag Tokyo 1999