[Hemorrhage caused by duodenal varices].
METHODS
A 53-year-old man had been passing tarry stools and bright red blood per rectum for 6 days. He had a history of pyloroplasty for duodenal ulcers, alcoholic liver cirrhosis, stage B in Child's classification, a Le Veen shunt for ascites, grade I oesophageal varices and several episodes of intestinal bleeding of uncertain cause on repeated endoscopies. Haemoglobin levels was now 4.4 g/dl. Neither oesophago-gastro-duodenoscopy nor colposcopy, radiological examination of the small intestine nor scintigraphy discovered the source of bleeding. Computed tomography revealed varices in the horizontal part of the duodenum, confirmed by arteriography.


METHODS
At a second endoscopy, this time with a long scope, acute bleedings were seen in the venous convolutions and stopped with 4 ml Polidocanol. Bleeding recurred after 10 days, thought to be due to persisting portal hypertension. A transjugular intrahepatic portosystemic stent shunt (TIPSS) was inserted to lower the pressure. Colour-coded Doppler examination at the time of another bleeding 10 weeks later demonstrated occlusion of the TIPSS. It was re-opened by balloon catheter dilatation, since when there have been no further episodes of bleeding.


CONCLUSIONS
The implantation of a TIPSS is a new causative treatment for recurrent bleeding from ectopic varices due to portal hypertension that cannot be treated by endoscopy.
Born
P
P
II. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München.
Huber
W
W
Neuhaus
H
H
Classen
M
M
D000792:Angiography; D004384:Duodenoscopy; D004386:Duodenum / Q000098:blood supply* / Q000000981:diagnostic imaging; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000077423:Polidocanol; D011092:Polyethylene Glycols / Q000627:therapeutic use; D011170:Portasystemic Shunt, Surgical; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015607:Stents; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy
D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols
Duodenalvarizenblutung.