title: Ectopic varices rupture in the gastroduodenal anastomosis successfully treated with N-butyl-2-cyanoacrylate injection.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi Gunma 371-0014, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Onozato
authors.forename: Satoru
authors.initials: S
authors.lastname: Kakizaki
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Iizuka
authors.forename: Kazuyo
authors.initials: K
authors.lastname: Mori
authors.forename: Daichi
authors.initials: D
authors.lastname: Takizawa
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ohyama
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Arakawa
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Arai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ishihara
authors.forename: Takehiko
authors.initials: T
authors.lastname: Abe
authors.forename: Naondo
authors.initials: N
authors.lastname: Sohara
authors.forename: Ken
authors.initials: K
authors.lastname: Sato
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takagi
authors.forename: Masatomo
authors.initials: M
authors.lastname: Mori
mesh_terms: 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
chemical_list: D014014:Tissue Adhesives; D004659:Enbucrilate