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A case of mediastinal fibrosis due to radiotherapy and ‘downhill’ esophageal varices: a rare cause of upper gastrointestinal bleeding

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Abstract

‘Downhill’ varices are located in the proximal part of the esophagus. Their etiology differs from the distal types, with most of them usually being related to superior vena cava obstruction. Although bleeding due to ‘downhill’ varices is very rare, it can be life-threatening. Here, we present a case of upper gastrointestinal bleeding due to mediastinal fibrosis associated with chest radiotherapy for seminoma metastasis sixteen years previously, which was successfully treated conservatively.

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References

  1. Felson B, Lessure AP. Downhill varices of the esophagus. Dis Chest. 1964;46:740–6.

    Article  CAS  PubMed  Google Scholar 

  2. Sheiner NM, Palayew MJ. “Downhill” esophageal varices in superior vena caval obstruction. Can Med Assoc J. 1969;100:961–4.

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Tavakkoli H, Asadi M, Haghighi M, et al. Therapeutic approach to “downhill” esophageal varices bleeding due to superior vena cava syndrome in Behcet’s disease: a case report. BMC Gastroenterol. 2006;27(6):43.

    Article  Google Scholar 

  4. St Dechambre, Dorzee J, Fastrez J, et al. Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy. Eur Respir J. 1998;11:1188–90.

    Article  Google Scholar 

  5. Basaranoglu M, Ozdemir S, Celik AF, et al. A case of fibrosing mediastinitis with obstruction of superior vena cava and downhill esophageal varices: a rare cause of upper gastrointestinal hemorrhage. J Clin Gastroenterol. 1999;28:268–70.

    Article  CAS  PubMed  Google Scholar 

  6. Glanz S, Koser MW, Dallemand S, et al. Upper esophageal varices: report of three cases and review of the literature. Am J Gastroenterol. 1982;77:194–8.

    CAS  PubMed  Google Scholar 

  7. Criado E, Marston WA, Jaques PF, et al. Proximal venous outflow obstruction in patients with upper extremity arteriovenous dialysis access. Ann Vasc Surg. 1994;8:530–5.

    Article  CAS  PubMed  Google Scholar 

  8. Basar N, Cagli K, Basar O, et al. Upper-extremity deep vein thrombosis and downhill esophageal varices caused by long-term pacemaker implantation. Tex Heart Inst J. 2010;37:714–6.

    PubMed Central  PubMed  Google Scholar 

  9. Tincani E, Criscuolo C, Zenesini A, et al. An unusual site of bleeding from esophageal varices. Recenti Prog Med. 1998;89:301–3.

    CAS  PubMed  Google Scholar 

  10. Serin E, Ozer B, Gümürdülü Y, et al. A case of Castleman’s disease with “downhill” varices in the absence of superior vena cava obstruction. Endoscopy. 2002;34:160–2.

    Article  CAS  PubMed  Google Scholar 

  11. Areia M, Romãozinho JM, Ferreira M, et al. “Downhill” varices. A rare cause of esophageal hemorrhage. Rev Esp Enferm Dig. 2006;98:359–61.

    Article  CAS  PubMed  Google Scholar 

  12. Pop A, Cutler AF. Bleeding downhill esophageal varices: a complication of upper extremity hemodialysis access. Gastrointest Endosc. 1998;47:299–303.

    Article  CAS  PubMed  Google Scholar 

  13. Otten TR, Stein PD, Patel KC, et al. Tromboembolic disease involving the superior vena cava and brachiocephalic veins. Chest. 2003;123:809–12.

    Article  PubMed  Google Scholar 

  14. Sherrick AD, Brown LR, Harms GF, et al. The radiologic findings of fibrosing mediastinitis. Chest. 1994;106:484–9.

    Article  CAS  PubMed  Google Scholar 

  15. van* der Veldt AA, Hadithi M, Paul MA, et al. An unusual cause of hematemesis: Goiter. World J Gastroenterol. 2006;12:5412–5.

    PubMed Central  PubMed  Google Scholar 

  16. Heller SL, Meyer JR, Russell EJ. Spinal cord venous infarction following endoscopic sclerotherapy for esophageal varices. Neurology. 1996;47:1081–5.

    Article  CAS  PubMed  Google Scholar 

  17. Boyce GA, Boyce HW. Esophagus:anatomy and structural anomalies. In: Yamaria T, Alpers DH, Owyang C, Powell DW, Silverstein FE, editors. Textbook of gastroenterology. Philadelphia: Lippincott; 1995.

    Google Scholar 

  18. Tsokos M, Bartel A, Schoel R, et al. Fatal pulmonary embolism after endoscopic embolization of downhill esophageal varix. Dtsch Med Wochenschr. 1998;123:691–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

The authors thank Gamze Kılıcoglu, MD, and Sirin Yasar, MD, for their contributions during revision of the manuscript.

Disclosures

Conflict of Interest: Authors (Bulent Yasar and Evren Abut) declare that they have no conflict of interest.

Human/Animal Rights: All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed Consent: Informed consent was obtained from the patient.

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Authors and Affiliations

  1. Department of Gastroenterohepatology, Camlica Erdem Hospital, Alemdag Yanyol Street, Uskudar, Istanbul, 34696, Turkey

    Bulent Yasar

  2. Department of Gastroenterohepatology, Umraniye Erdem Hospital, Istanbul, Turkey

    Evren Abut

Authors
  1. Bulent Yasar
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  2. Evren Abut
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Correspondence to Bulent Yasar.

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Yasar, B., Abut, E. A case of mediastinal fibrosis due to radiotherapy and ‘downhill’ esophageal varices: a rare cause of upper gastrointestinal bleeding . Clin J Gastroenterol 8, 73–76 (2015). https://doi.org/10.1007/s12328-015-0555-1

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  • DOI: https://doi.org/10.1007/s12328-015-0555-1

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