title: Hemorrhagic ascites from spontaneous ectopic mesenteric varices rupture in NASH induced cirrhosis and successful outcome: a case report.
abstract: Bleeding from gastro-esophageal varices can often present as the first decompensating event in patients with cirrhosis. This can be a potentially life threatening event associated with a 15%-20% early mortality. We present a rare case of new onset ascites due to intra-abdominal hemorrhage from ruptured mesenteric varices; in a 37 years old male with newly diagnosed nonalcoholic steatohepatitis induced cirrhosis as the first decompensating event. The patient was successfully resuscitated with emergent evacuation of ascites for diagnosis, identification and control of bleeding mesenteric varices and eventually orthotopic liver transplantation with successful outcome. Various clinical presentations, available treatment options and outcomes of ectopic variceal bleeding are discussed in this report.
authors.affiliation: Raja GR Edula, Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
authors.forename: Raja G R
authors.initials: RG
authors.lastname: Edula
authors.affiliation: Raja GR Edula, Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
authors.forename: Kamran
authors.initials: K
authors.lastname: Qureshi
authors.affiliation: Raja GR Edula, Department of Medicine, Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ 07103, United States.
authors.forename: Hicham
authors.initials: H
authors.lastname: Khallafi
mesh_terms: D000328:Adult; D001201:Ascites / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D001706:Biopsy; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006489:Hemostatic Techniques; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D012151:Resuscitation; D012422:Rupture, Spontaneous; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Cirrhosis; Ectopic varices; Hemorrhagic ascites, Portal hypertension; Nonalcoholic steatohepatitis; Orthotopic liver transplantation