title: Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices.
abstract: Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report a 65-year-old woman who presented with hematemesis and melena. She was admitted to our department because of prolonged shock, despite having received transfusion of a large volume of blood. Upper gastrointestinal endoscopy revealed nodular varices with active bleeding in the second portion of the duodenum. Endoscopic injection sclerotherapy (EIS) was performed using a tissue adhesive agent, alpha-cyanoacrylate monomer, with only temporary benefit. However, anemia continued to progress after the procedure. Therefore, we combined transileocolic vein obliteration (TIO) with balloon-occluded retrograde transvenous obliteration (B-RIO), using 5% ethanolamine oleate with iopamidol to obliterate the varices. Complete hemostasis was achieved without complications. Neither recurrence of varices nor further bleeding has occurred for over 3 years. We conclude that combined TIO and B-RTO, which can obstruct both the feeding and the draining vessels of duodenal varices to retain the sclerosing agent completely in the varices, is a safe and effective hemostatic measure for ruptured duodenal varices, when EIS has failed to accomplish complete hemostasis.
authors.affiliation: Department of Emergency and Critical Care Medicine, School of Medicine, School of Medicine, Fukuoka University, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ota
authors.forename: M
authors.initials: M
authors.lastname: Okazaki
authors.forename: H
authors.initials: H
authors.lastname: Higashihara
authors.forename: H
authors.initials: H
authors.lastname: Kokawa
authors.forename: Z
authors.initials: Z
authors.lastname: Shirai
authors.forename: A
authors.initials: A
authors.lastname: Anan
authors.forename: Y
authors.initials: Y
authors.lastname: Kitamura
authors.forename: H
authors.initials: H
authors.lastname: Shijo
mesh_terms: D000368:Aged; D004386:Duodenum / Q000098:blood supply*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control*; D016558:Hemostasis, Endoscopic; D006801:Humans; D008026:Ligation; D012422:Rupture, Spontaneous; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy / Q000379:methods; D014648:Varicose Veins / Q000473:pathology / Q000628:therapy*
chemical_list: D012597:Sclerosing Solutions