Hemorrhagic duodenal varices treated successfully with endoscopic injection sclerotherapy using cyanoacrylate and ethanolamine-oleate: a case report.
We report a case of a 50-year-old man with a medical history of alcoholic cirrhosis, in addition to esophagogastric and duodenal varices (DV), who was transferred to our institution because of hemorrhagic DV. Emergent esophagogastroduodenoscopy showed hemorrhagic varices in the horizontal portion of the duodenum. Abdominal contrast-enhanced CT showed hemodynamics of DV derived from anastomosis between the superior mesenteric vein and right renal vein. Cyanoacrylate was injected into the DV. Subsequently, 5% ethanolamine-oleate was injected endoscopically as a sclerosant into the DV feeding vein. Radiographic fluoroscopic findings revealed that the injected cyanoacrylate and sclerosant remained, respectively, in the varices and its feeder. Five days later, CT showed that the injected cyanoacrylate occupied the DV, and thrombus formation of the afferent vein led to bifurcation of superior mesenteric vein. This case showed the usefulness of endoscopic injection sclerotherapy using cyanoacrylate and sclerosant for the management of DV.
Suzuki
Rei
R
Department of Gastroenterology and Rheumatology, Division of Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan.
Irisawa
Atsushi
A
Hikichi
Takuto
T
Shibukawa
Goro
G
Takagi
Tadayuki
T
Wakatsuki
Takeru
T
Imamura
Hidemichi
H
Takahashi
Yuta
Y
Sato
Ai
A
Sato
Masaki
M
Ikeda
Tsunehiko
T
Tasaki
Kazuhiro
K
Obara
Katsutoshi
K
Ohira
Hiromasa
H
D003487:Cyanoacrylates / Q000627:therapeutic use; D004386:Duodenum / Q000098:blood supply*; D016145:Endoscopy, Digestive System; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use; D012597:Sclerosing Solutions / Q000627:therapeutic use*; D015911:Sclerotherapy / Q000379:methods*; D014648:Varicose Veins / Q000150:complications / Q000628:therapy*
D003487:Cyanoacrylates; D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate