MANAGEMENT OF ECTOPIC VARIX WITH HISTOACRYL
AbstractUpper gastro-intestinal (GI) bleed is one of the most serious situations encountered in the emergency department. There is consensus regarding management of common causes of upper GI bleed but for rare causes no such consensus exists. We present a case of a 35 year old male who presented with 5–6 episodes of hematemesis associated with melena in 24 hours. On examination he was in hypotensive shock with no stigmata of chronic liver disease. Doppler studies showed portal vein thrombosis with cavernous transformation and varices in peripancreatic region and around duodenum. His upper GI endoscopy showed a large varix with ulceration in the duodenal bulb, indicating it as the source of bleeding. The varix was injected with 1cc of cyanoacrylate. The patient’s final diagnosis was non-cirrhotic portal hypertension secondary to portal vein thrombosis. At immediate and long term follow-up the patient had no complications. We conclude that cyanoacrylate injection effectively manages ectopic duodenal varices and can be used with a simple application technique.Keywords: Ectopic varices, hematemesis, upper gastro-intestinal endoscopy
El-Tawil AM. Trends on gastrointestinal bleeding and mortality: where are we standing? World J Gastroenterol 2012;18:1154–8.
Rockall TA, Logan RF, Devlin HB, Northfield TC. Incidence of and mortality from acute upper gastrointestinal haemorrhage in the United Kingdom. Steering Committee and members of the National Audit of Acute Upper Gastrointestinal Haemorrhage. BMJ. 1995;311:222–6.
Helmy A, Al Kahtani K, Al Fadda M. Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2008;2:322–34.
Saad WE, Saad NE, Koizumi J. Stomal varices: management with decompression tips and transvenous obliteration or sclerosis. Tech Vasc Interv Radiol 2013;16:176–84.
Sato T, Akaike J, Toyota J, Karino Y, Ohmura T. Clinicopathological features and treatment of ectopic varices with portal hypertension. Int J Hepatol 2011;960720.
Ghidirim G, Mishin I, Dolghii A, Zastavnitsky G. Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case. Chirurgia (Bucur). 2009;104:625–9.
Biecker E. Portal hypertension and gastrointestinal bleeding: Diagnosis, prevention and management. World J Gastroenterol 2013;19:5035–50.
Kim HH, Kim SE. Ruptured duodenal varices successfully managed by endoscopic N-butyl-2-cyanoacrylate injection. J Clin Med Res 2012;4:351–3.
Park SB, Lee SH, Kim JH, Lee HJ, Jang SP, Lee JN, et al. Successful treatment of duodenal variceal bleeding by endoscopic clipping. Clin Endosc 2013;46:403–6.
Hashimoto R, Sofue K, Takeuchi Y, Shibamoto K, Arai Y. Successful balloon-occluded retrograde transvenous obliteration for bleeding duodenal varices using cyanoacrylate. World J Gastroenterol 2013;19:951–4