title: Usefulness of multi-detector helical CT with multiplanar reconstruction for depicting the duodenal varices with multiple collateral shunt vessels.
abstract: Duodenal varices are a rare complication in patients with portal hypertension. Bleeding from duodenal varices often results in a severe prognosis. Diagnosis of the disease is usually based on findings obtained by endoscopy or angiography. However, it occasionally fails to detect the lesion and demonstrate its porto-systemic shunt vessels which are necessary information to decide an appropriate treatment. Recent advances in CT may make it possible for us to reveal duodenal varices with complicated porto-systemic shunt vessels. We report the case of a 58-year-old man with liver cirrhosis with repeated bleeding from duodenal varices. Esophagogastroduodenoscopy (EGD) revealed multinodular varices in the third portion of the duodenum. Then we conducted a capsule endoscopy (CE) and found fresh blood in the duodenum, suggesting duodenal variceal hemorrhage. Angiography depicted the varices with one afferent and two efferent vessels. Abdominal CT examination was conducted using a four-channel multi-detector row CT scanner. The multiplanar reconstructed images revealed not only the varices, but also three afferent and two efferent vessels. The patient was treated by surgical ligation and sclerotherapy, because of its complicated porto-systemic shunt and reserved liver function. No gastrointestinal bleeding has been seen after the surgery. Our case suggests the usefulness of multi-detector CT with multiplanar reconstruction (MPR) for the diagnosis and therapeutic decision of duodenal varices.
authors.forename: Shuntaro
authors.initials: S
authors.lastname: Yoshida
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Watabe
authors.forename: Masaaki
authors.initials: M
authors.lastname: Akahane
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Kyoden
authors.forename: Hanako
authors.initials: H
authors.lastname: Ishikawa
authors.forename: Atsuo
authors.initials: A
authors.lastname: Yamada
authors.forename: Takafumi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Miki
authors.initials: M
authors.lastname: Ohta
authors.forename: Keiji
authors.initials: K
authors.lastname: Ogura
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yamaji
authors.forename: Kuni
authors.initials: K
authors.lastname: Ohtomo
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
authors.forename: Masao
authors.initials: M
authors.lastname: Omata