Hepatology International

, Volume 4, Issue 4, pp 775–778 | Cite as

Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels

  • Shuntaro Yoshida
  • Hirotsugu Watabe
  • Masaaki Akahane
  • Yusuke Kyoden
  • Hanako Ishikawa
  • Atsuo Yamada
  • Takafumi Sugimoto
  • Miki Ohta
  • Keiji Ogura
  • Yutaka Yamaji
  • Kuni Ohtomo
  • Norihiro Kokudo
  • Kazuhiko Koike
  • Masao Omata
Case Report

Abstract

Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a four-channel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multi-detector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.

Keywords

Varices Computed tomography Duodenum Surgical hemostasis 

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Copyright information

© Asian Pacific Association for the Study of the Liver 2010

Authors and Affiliations

  • Shuntaro Yoshida
    • 1
  • Hirotsugu Watabe
    • 1
  • Masaaki Akahane
    • 2
  • Yusuke Kyoden
    • 3
  • Hanako Ishikawa
    • 1
  • Atsuo Yamada
    • 1
  • Takafumi Sugimoto
    • 1
  • Miki Ohta
    • 1
  • Keiji Ogura
    • 1
  • Yutaka Yamaji
    • 1
  • Kuni Ohtomo
    • 2
  • Norihiro Kokudo
    • 3
  • Kazuhiko Koike
    • 1
  • Masao Omata
    • 1
  1. 1.Department of Gastroenterology, Graduate School of MedicineUniversity of TokyoTokyoJapan
  2. 2.Department of Radiology, Graduate School of MedicineUniversity of TokyoTokyoJapan
  3. 3.Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of MedicineUniversity of TokyoTokyoJapan

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