title: A case of variceal bleeding from the jejunum in liver cirrhosis.
abstract: While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.
authors.affiliation: Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea.
authors.forename: Chan Woong
authors.initials: CW
authors.lastname: Park
authors.forename: Sae Hee
authors.initials: SH
authors.lastname: Kim
authors.forename: Hyeon Woong
authors.initials: HW
authors.lastname: Yang
authors.forename: Yun Jung
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sung Hee
authors.initials: SH
authors.lastname: Jung
authors.forename: Ho Sup
authors.initials: HS
authors.lastname: Song
authors.forename: Sang Ok
authors.initials: SO
authors.lastname: Lee
authors.forename: Anna
authors.initials: A
authors.lastname: Kim
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Cha
mesh_terms: D000792:Angiography; D053704:Capsule Endoscopy; D004621:Embolization, Therapeutic; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis; D005260:Female; D006471:Gastrointestinal Hemorrhage; D006801:Humans; D006975:Hypertension, Portal; D007579:Jejunal Diseases / Q000175:diagnosis* / Q000628:therapy; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008551:Melena / Q000150:complications; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: Jejunal varices; Liver cirrhosis; Portal hypertension