title: Peripapillary duodenal varices as a rare cause of severe bleeding in a patient with no other signs of portal hypertension--successful endoscopic treatment with cyanoacrylate injection.
abstract: Duodenal varices (DVs) are a rare cause of upper gastrointestinal bleeding and rather suspected in patients with portal hypertension. Bleeding DVs are difficult to manage and often fatal due to delayed diagnosis. We report on a 71-year-old patient with massive upper gastrointestinal haemorrhage, who did not show any clinical signs of portal hypertension; however, he had a history of duodenal segmental resection 8 years before. The source of bleeding could not be detected with different imaging methods such as angiography and computed tomography. Upper gastrointestinal endoscopy finally revealed DVs, which were located just adjacent to the papilla. After endoscopic injection therapy with n-butyl 2-cyanoacrylate the bleeding stopped immediately and the patient soon stabilised. Despite the peripapillar localisation no signs of pancreatitis or cholestasis occurred; during 10-month follow-up a marked regression of the varices without further signs of variceal bleeding was observed.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover. tobias.weismueller@gmx.de
authors.forename: T J
authors.initials: TJ
authors.lastname: Weismüller
authors.forename: N
authors.initials: N
authors.lastname: Schweitzer
authors.forename: B
authors.initials: B
authors.lastname: Boozari
authors.forename: A
authors.initials: A
authors.lastname: Negm
authors.forename: D
authors.initials: D
authors.lastname: Bürger
authors.forename: M P
authors.initials: MP
authors.lastname: Manns
authors.forename: J
authors.initials: J
authors.lastname: Wedemeyer
authors.forename: S
authors.initials: S
authors.lastname: Kubicka
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003487:Cyanoacrylates / Q000627:therapeutic use*; D004378:Duodenal Diseases / Q000150:complications* / Q000628:therapy; D016099:Endoscopy, Gastrointestinal; D006471:Gastrointestinal Hemorrhage / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008297:Male; D014014:Tissue Adhesives / Q000627:therapeutic use; D016896:Treatment Outcome; D014648:Varicose Veins / Q000150:complications* / Q000628:therapy
chemical_list: D003487:Cyanoacrylates; D014014:Tissue Adhesives