Small bowel varices from neuroendocrine tumor of the pancreas.
Small bowel varices (SBVs) are a rare but important cause of gastrointestinal (GI) bleeding. We present a case of SBVs caused by superior mesenteric vein thrombosis from a large neuroendocrine tumor of the pancreas. This patient presented with GI bleeding. A computed tomography scan showed an incidental hypervascular mass that was unresectable. After exhaustive work-up, the GI bleeding was in fact due to the mass by direct compression on the superior mesenteric vein. The SBVs were evident on the venous phase of a computed tomography angiogram. The patient was treated medically with octreotide, beta-blockade, and external beam radiation therapy applying the physiology of esophagogastric varices to the small bowel. Persistent GI bleeding in the presence of a large central mass should always alert one to consider varices from collateral flow as a possible cause.
Shah
Shimul A
SA
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA. shimul.shah@uhn.on.ca
Mery
Carlos M
CM
Zinner
Michael J
MJ
D000369:Aged, 80 and over; D003251:Constriction, Pathologic / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply*; D008641:Mesenteric Vascular Occlusion / Q000209:etiology; D008642:Mesenteric Veins / Q000473:pathology; D018358:Neuroendocrine Tumors / Q000150:complications*; D010190:Pancreatic Neoplasms / Q000150:complications*; D014648:Varicose Veins / Q000209:etiology*; D020246:Venous Thrombosis / Q000209:etiology