title: Gastrointestinal bleeding 30 years after a complicated cholecystectomy.
abstract: Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from small-bowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled by endoscopic injection of cyanoacrylate. Intraoperative endoscopy should be considered in the case of life-threatening gastrointestinal hemorrhage that is not accessible by conventional endoscopy.
authors.affiliation: Department of Gastroenterology and Hepatology, Berufsgenossenschaftliche Kliniken Bergmannsheil, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. thorsten.brechmann@rub.de
authors.forename: Thorsten
authors.initials: T
authors.lastname: Brechmann
authors.forename: Wolff
authors.initials: W
authors.lastname: Schmiegel
authors.forename: Volkmar
authors.initials: V
authors.lastname: Nicolas
authors.forename: Markus
authors.initials: M
authors.lastname: Reiser
mesh_terms: D000368:Aged; D002763:Cholecystectomy / Q000009:adverse effects*; D003487:Cyanoacrylates / Q000627:therapeutic use; D058582:Double-Balloon Enteroscopy; D004724:Endoscopy / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000601:surgery; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D016896:Treatment Outcome
chemical_list: D003487:Cyanoacrylates