Contrast-enhanced three-dimensional magnetic resonance angiography for visualization of ectopic varices.
We report the case of a 62-year-old male with portal hypertension and recurrent bleeding refractory to surgical intervention from varices in a sigmoid stoma. Although stomal varices were detected neither by physical examination, stomal endoscopy, nor duplex sonography, contrast-enhanced three-dimensional magnetic resonance angiography of the portal vein and its collateral branches demonstrated their presence. Surgical revisions of the stoma failed to prevent bleeding, but implantation of a transjugular intrahepatic shunt successfully prevented recurrent hemorrhage. This case indicates that contrast-enhanced, three-dimensional magnetic resonance angiography is useful to detect this rare complication of portal hypertension and helps to tailor adequate treatment in patients with recurrent bleeding from stomal varices.
Handschin
Alexander E
AE
Department of Visceral Surgery and Transplantation, University Hospital of Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
Weber
Markus
M
Weishaupt
Dominik
D
Fried
Michael
M
Clavien
Pierre-Alain
PA
D003287:Contrast Media; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000628:therapy; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012008:Recurrence; D012810:Sigmoid Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D054047:Surgical Stomas / Q000098:blood supply*; D016896:Treatment Outcome; D014648:Varicose Veins / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy
D003287:Contrast Media