Skip to main content

Advertisement

SpringerLink
Log in

Transabdominal color Doppler ultrasonography for the diagnosis of small intestinal and vesical varices in a patient successfully treated with percutaneous transhepatic obliteration

  • Case Report
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

A 52-year-old asymptomatic female was admitted to our hospital in January 2008 with enlarged esophageal varices due to alcoholic liver cirrhosis. Color Doppler ultrasonographic examination showed images of vessels on the small intestinal wall around the umbilical area and the anterior wall of the bladder. Images of the vessels were obtained for the small intestinal wall and the anterior wall of the bladder with computed tomography. Percutaneous transhepatic portography was performed, and hepatofugal blood flow was observed in the inferior epigastric vein connected to the superior mesenteric vein and the contrast medium passed into the small intestinal varices and the vesical varices, which drained into the right ovarian vein. Percutaneous transhepatic obliteration was then successfully performed via the afferent veins of the small intestinal varices and vesical varices. One week after the treatment, color Doppler ultrasonography showed a remarkable decrease in blood flow in the varices.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Walsh G, Williams MP. Case report: giant pararectal varices-computed tomographic appearances. Br J Radiol. 1995;68:203–4.

    Article  CAS  PubMed  Google Scholar 

  2. Kinkhabwala M, Mousavi A, Iyer S, Adamsons R. Bleeding ileal varicosity demonstrated by transhepatic portography. Am J Roentgenol. 1977;129:514–6.

    CAS  Google Scholar 

  3. Norton ID, Andrews JC, Kamath PS. Management of ectopic varices. Hepatology. 1988;28:1154–8.

    Article  Google Scholar 

  4. Lebrec D, Benhamou JP. Ectopic varices in portal hypertension. Clin Gastroenterol. 1985;14:105–21.

    CAS  PubMed  Google Scholar 

  5. Bhagwat SS, Borwankar SS, Ramadwar RH, Naik AS, Gajaree GI. Isolated jejunal varices. J Post Med. 1995;41:43–4.

    CAS  Google Scholar 

  6. Migou S, Hashizume M, Tsugawa K, et al. Jejunal variceal bleeding after esophageal transaction in a patient with idiopathic portal hypertension. Hepatogastroenterology. 1998;45:503–7.

    CAS  PubMed  Google Scholar 

  7. Sato T, Yasui O, Kurosawa T, Hashimoto M, Asanuma Y, Koyama K. Jejunal varix with extrahepatic portal obstruction treated by embolization using interventional radiology: report of a case. Surg Today. 2003;33:131–4.

    Article  PubMed  Google Scholar 

  8. Ota S, Suzuki S, Mitsuoka H, et al. Effect of a portal venous stent for gastrointestinal hemorrhage from jejunal varices caused by portal hypertension after pancreatoduodenectomy. J Hepatobiliary Pancreat Surg. 2005;12:88–92.

    Article  PubMed  Google Scholar 

  9. Lim LG, Lee YM, Tan L, Chang S, Lim SG. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. World J Gastroenterol. 2009;15:3823–6.

    Article  PubMed  Google Scholar 

  10. Falchuck KR, Aiello MR, Trey C, Costello P. Recurrent gastrointestinal bleeding from ileal varices associated with intraabdominal adhesions: case report and review of literature. J Gastroenterol. 1982;77:859–60.

    Google Scholar 

  11. Arst HF, Reynolds JD. Acute ileal variceal hemorrhage secondary to esophageal sclerotherapy. J Clin Gastroenterol. 1986;5:603–4.

    Article  Google Scholar 

  12. Hojhus JH, Pedersen SA. Cirrhosis and bleeding ileal varices without previous intraabdominal surgery. A case report. Acta Chir Scand. 1986;152:479–80.

    CAS  PubMed  Google Scholar 

  13. Lewis P, Warren BF, Bartolo DC. Massive gastrointestinal hemorrhage due to ileal varices. Br J Surg. 1990;77:1277–8.

    Article  CAS  PubMed  Google Scholar 

  14. Ohtani T, Kajiwara E, Suzuki N, Kawasaki A, Sadoshima S, Sakata H, et al. Ileal varices associated with recurrent bleeding in a patient with liver cirrhosis. J Gastroenterol. 1999;34:264–8.

    Article  CAS  PubMed  Google Scholar 

  15. Kobayashi K, Yamaguchi J, Mizoe A, Isomoto I, Koshiishi T, Izawa K, et al. Successful treatment of bleeding due to ileal varices in a patient with hepatocellular carcinoma. Eur J Gastroenterol Hepatol. 2001;13:63–6.

    Article  CAS  PubMed  Google Scholar 

  16. Guth E, Katz MD, Hanks SE, Teitelbaum GP, Ralls P, Korula J. Recurrent bleeding from ileal varices treated by transjugular intrahepatic shunt: value of Doppler ultrasonography in diagnosis and follow-up. J Ultrasound Med. 1996;15:67–9.

    CAS  PubMed  Google Scholar 

  17. Varanasi RV, Fleischer AS, Darwin PE, King CE, Haluszka O. Colonoscopic sclerotherapy of ileal varices. Gastrointest Endosc. 2000;52:109–11.

    Article  CAS  PubMed  Google Scholar 

  18. Sano K, Shuin T, Takebayashi S, et al. A case of vesical varices as a complication of portal hypertension and manifested gross hematuria. J Urol. 1989;141:369–71.

    CAS  PubMed  Google Scholar 

  19. Lugagne PM, Castaing D, Conort P, Guerrieri M, Bousquet O, Chatelain C. Portal hypertension––a rare cause of haematuria. Prog Urol. 1992;2:294–8.

    CAS  PubMed  Google Scholar 

  20. Loganathan G, Shyamkumar NK, Kurian G, Eapen CE, Korah IP, Gnanaraj L, Chandy GM. Vesical varix in cirrhosis of liver. Indian J Gastroenterol. 2000;19:193–4.

    CAS  PubMed  Google Scholar 

  21. Gaspar Y, Detry O, Leval J. Vesical varices in a patient with portal hypertension. N Engl J Med. 2001;345:1503–4.

    Article  CAS  PubMed  Google Scholar 

  22. The Veterans Affairs Cooperative Variceal Sclerotherapy Group. Prophylactic sclerotherapy for esophageal varices in men with alcoholic liver disease. N Engl J Med. 1991;324:1779–84.

    Article  Google Scholar 

  23. Goff GV, Reveille RM, Stiegmann GV. Endoscopic sclerotherapy versus endoscopic variceal ligation: esophageal symptoms, complications and motility. Am J Gastroenterol. 1988;83:1240–4.

    CAS  PubMed  Google Scholar 

  24. Kanagawa H, Mima S, Kouyama H, Gotoh K, Uchida T, Okuda K. Treatment of gastric fundal varices by balloon-occluded retrograde transvenous obliteration. Gastroenterol Hepatol. 1996;11:51–8.

    Article  CAS  Google Scholar 

  25. Haruta I, Isobe Y, Ueno E, Toda J, Mitsunaga A, Noguchi S, et al. Balloon-occluded retrograde transvenous obliteration (BRTO), a promising nonsurgical therapy for ectopic varices. Am J Gastroenterol. 1996;91:2594–7.

    CAS  PubMed  Google Scholar 

  26. Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Akaike J. Ileal varices treated with balloon-occluded retrograde transvenous obliteration. Gastroenterol Res. 2009;2:122–5.

    Google Scholar 

  27. Ueno N, Sasaki A, Tomiyama T, Tano S, Kimura K. Color Doppler ultrasonography in the diagnosis of cavernous transformation of the portal vein. J Clin Ultrasound. 1997;25:227–33.

    Article  CAS  PubMed  Google Scholar 

  28. Komatsuda T, Ishida H, Konno K, et al. Color Doppler findings of gastrointestinal varices. Abdom Imaging. 1998;23:45–50.

    Article  CAS  PubMed  Google Scholar 

  29. Maruyama H, Okugawa H, Yoshizumi H, Kobayashi S, Yokosuka O. Hemodynamic features of gastrorenal shunt: a Doppler study in cirrhotic patients with gastric fundal varices. Acad Radiol. 2008;15:1148–54.

    Article  PubMed  Google Scholar 

  30. Sato T, Yamazaki K, Akaike J. Diagnosis of gastric varices and evaluation of the effectiveness of treatment using transabdominal color Doppler ultrasonography. J Ultrasound Med. 2009;28:1125–31.

    PubMed  Google Scholar 

  31. Tang SJ, Zanati S, Dubcenco E, et al. Diagnosis of small-bowel varices by capsule endoscopy. Gastrointest Endosc. 2004;60:129–35.

    Article  PubMed  Google Scholar 

  32. De Palma G, Rega M, Masone S, et al. Mucosal abnormalities in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointest Endosc. 2005;62:529–34.

    Article  PubMed  Google Scholar 

  33. Goulas S, Triantafyllidou K, Karagiannis S, et al. Capsule endoscopy in the investigation of patients with portal hypertension and anemia. Can J Gastroenterol. 2008;22:469–74.

    PubMed  Google Scholar 

Download references

Conflict of interest statement

The author had no financial relationships to disclose that are relevant to this publication.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sapporo Kosei General Hospital, Kita 3 Higashi 8, Chuo-ku, Sapporo, 060-0033, Japan

    Takahiro Sato

Authors
  1. Takahiro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takahiro Sato.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sato, T. Transabdominal color Doppler ultrasonography for the diagnosis of small intestinal and vesical varices in a patient successfully treated with percutaneous transhepatic obliteration. Clin J Gastroenterol 3, 214–218 (2010). https://doi.org/10.1007/s12328-010-0164-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-010-0164-y

Keywords

Search

Navigation