title: Percutaneous trans-hepatic obliteration for bleeding esophagojejunal varices after total gastrectomy and esophagojejunostomy.
abstract: A 72-year-old man who had undergone a total gastrectomy with a Roux-en-Y esophagojejunostomy for gastric cancer 6 years earlier presented to our hospital with massive hematemesis and melena. Endoscopic examination indicated esophageal varices with cherry-red spots and hemorrhage arising from beyond the anastomosis. Abdominal contrast-enhanced computed tomography and angiography revealed a dilated vein in the elevated jejunal limb supplying the varices. Percutaneous trans-hepatic obliteration (PTO) of the varices through the jejunal vein was performed using microcoils, ethanolamine oleate, and gelatin sponge cubes. Ten days after the procedure, endoscopic examination revealed reduction and thrombosis of the varices. We consider PTO to be an effective alternative method for treating ruptured esophagojejunal varices after total gastrectomy.
authors.affiliation: Department of Radiology, Shinko-Kakogawa Steel Hospital, 797-295, Isshiki, Hiraoka-cho, Kakogawa, 675-0115, Japan.
authors.forename: Michiko
authors.initials: M
authors.lastname: Boku
authors.forename: Koji
authors.initials: K
authors.lastname: Sugimoto
authors.forename: Tetsu
authors.initials: T
authors.lastname: Nakamura
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Kita
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Zamora
authors.forename: Kazuro
authors.initials: K
authors.lastname: Sugimura
mesh_terms: D000368:Aged; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D021721:Balloon Occlusion; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000209:etiology* / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects; D005743:Gastrectomy / Q000009:adverse effects; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007582:Jejunostomy / Q000009:adverse effects; D007583:Jejunum / Q000098:blood supply* / Q000601:surgery; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D011169:Portal Vein / Q000601:surgery; D012086:Reoperation; D013162:Splenic Vein / Q000601:surgery; D013274:Stomach Neoplasms / Q000601:surgery; D014648:Varicose Veins / Q000209:etiology / Q000628:therapy