title: Successful endoscopic hemostasis for ruptured duodenal varices after balloon-occluded retrograde transvenous obliteration.
abstract: A 75-year-old man with general malaise and appetite loss was transferred to our hospital for assessment and treatment of liver failure. Laboratory findings on admission showed anemia, and gastroduodenoscopy (GDS) revealed linear esophageal varices and tensive duodenal varices (DV) in the second portion of the duodenum. Systemic examinations did not reveal any significant lesion capable of explaining his anemia, except for DV. Balloon-occluded retrograde transvenous obliteration was carried out to prevent DV bleeding. Good pooling of sclerosant was observed using two balloon catheters. However, contrast-enhanced computed tomography after the procedure revealed no thrombosis in DV, and the patient complained of tarry stools before additional therapy. Emergent GDS revealed ruptured DV with fresh blood and erosions on the surface. Emergent endoscopic obliteration using the tissue adhesive N-butyl-2-cyanoacrylate was carried out and complete hemostasis was achieved. Although no rebleeding episodes were observed after emergent obliteration, the patient died of sepsis following spontaneous bacterial peritonitis 53 days after admission. Autopsy revealed that DV dropped out, and the deep vein was replaced by granulation tissue. No signs of thrombi were detected, except varices. This autopsy case revealed the difficulty in DV management.
authors.affiliation: Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan. sogatti@koto.kpu-m.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Soga
authors.forename: Koichi
authors.initials: K
authors.lastname: Tomikashi
authors.forename: Kohei
authors.initials: K
authors.lastname: Fukumoto
authors.forename: Ki-Ichirou
authors.initials: K
authors.lastname: Miyawaki
authors.forename: Kotaro
authors.initials: K
authors.lastname: Okuda
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Konishi
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Yagi
authors.forename: Naoki
authors.initials: N
authors.lastname: Wakabayashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kokura
authors.forename: Yuji
authors.initials: Y
authors.lastname: Naito
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Yoshikawa
mesh_terms: D000368:Aged; D021721:Balloon Occlusion / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000628:therapy*; D004659:Enbucrilate / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D017809:Fatal Outcome; D016558:Hemostasis, Endoscopic; D006801:Humans; D008297:Male; D012421:Rupture; D014648:Varicose Veins / Q000628:therapy*
chemical_list: D004659:Enbucrilate