Zusammenfassung
Akute gastrointestinale Blutungen sind bei Leberzirrhosepatienten mit einer hohen Mortalität verbunden. Ileale Varizen und Kollateralen aus anderen ektopen Gefäßen des Darms sind extrem selten und treten bei weniger als 5% aller Zirrhosepatienten auf. Die Diagnosestellung erfolgt oft verspätet, da die üblichen diagnostischen Untersuchungsmethoden wie Gastroskopie oder Koloskopie in den meisten Fällen die Blutungsquelle nicht ausreichend darstellen.
Wir berichten über einen ungewöhnlichen Fall von massiver und unkontrollierbarer unterer gastroinstestinaler (GI-)Blutung aus ilealen Varizen mit Verbindung zur rechten V. ovarica einer 56-jährigen Frau, bei der anamnestisch eine Leberzirrhose und abdominelle Operationen sowie Operationen im Bereich des Beckens bekannt waren. Die genaue angiographische und computertomographische Diagnose erlaubte eine rasche Dekompression des Portalvenensystems mittels eines transjugulären portosystemischen Shunts.
Abstract
Acute gastrointestinal bleeding in patients with liver cirrhosis is associated with a high mortality. Ileal varices and collaterals from ectopic vessels are extremely rare, encountered in less than 5% of the cirrhotic patients. The diagnosis is frequently delayed because the regular diagnostic methods such as gastroscopy or colonoscopy are unsuccessful in accurate the source of bleeding in the majority of the cases.
We report an unusual case of massive and uncontrollable lower intestinal bleeding from ileal varices with right ovarian vein anastomosis in a 56 year-old female patient with liver cirrhosis and previous history of abdominal and pelvic surgery. The accurate angiographic and computed tomography diagnosis allowed fast decompression of the portal venous system using a transjugular intrahepatic portosystemic shunt.
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López-Benítez, R., Seidensticker, P., Richter, G.M. et al. Fallbericht: Massive untere gastrointestinale Blutung aus ilealen Varizen. Radiologe 47, 407–410 (2007). https://doi.org/10.1007/s00117-005-1279-x
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DOI: https://doi.org/10.1007/s00117-005-1279-x