Ectopic varices rupture in the gastroduodenal anastomosis successfully treated with N-butyl-2-cyanoacrylate injection.
The term "ectopic varices" is used to describe dilated portosystemic collateral veins in unusual locations other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70-year-old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth-I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices, there were no obvious bleeding points. After removal of the coagula, ectopic varices and a fibrin plug were observed on the gastroduodenal anastomosis. During the observation, blood began to spurt from the fibrin plug. N-butyl-2-cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood flow around the bleeding point, as indicated by lipiodol deposition, had decreased, and no feeding vein was observed. Endoscopic and angiographic findings are shown and the treatment for such lesions is discussed.
Onozato
Yasuhiro
Y
Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi Gunma 371-0014, Japan.
Kakizaki
Satoru
S
Iizuka
Haruhisa
H
Mori
Kazuyo
K
Takizawa
Daichi
D
Ohyama
Tatsuya
T
Arakawa
Kazuhisa
K
Arai
Hirotaka
H
Ishihara
Hiroshi
H
Abe
Takehiko
T
Sohara
Naondo
N
Sato
Ken
K
Takagi
Hitoshi
H
Mori
Masatomo
M
D000368:Aged; D000714:Anastomosis, Surgical; D000792:Angiography; D004386:Duodenum / Q000098:blood supply; D004659:Enbucrilate / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005743:Gastrectomy; D006471:Gastrointestinal Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008297:Male; D012421:Rupture; D014014:Tissue Adhesives / Q000627:therapeutic use*; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology
D014014:Tissue Adhesives; D004659:Enbucrilate