title: Successful emergency combined therapy with partial splenic arterial embolization and endoscopic injection therapy against a bleeding duodenal varix in a child.
abstract: There is no consensus guidelines for treating duodenal variceal bleeding, which is a rare and life-threatening complication of portal hypertension. Here we report an exceedingly unusual case in a 9-year-old boy who had developed left-sided portal hypertension after surgical treatment for pancreatoblastoma followed by a duodenal variceal bleeding with massive melena, severe anemia (hemoglobin 4.5 g/dL) and hypovolemic shock. Emergency partial splenic arterial embolization (PSE) provided a reduction of variceal bleeding and improved blood pressure. Endoscopic injection sclerotherapy (EIS) was subsequently performed and stopped the duodenal variceal bleeding without the complication of portal vein thrombosis caused by injected sclerosant under hepatopetal flow. Our case demonstrates that emergency combined therapy with PSE and EIS can be considered as the therapeutic option for the management of left-sided portal hypertension-induced ectopic variceal bleedings in order to avoid the complication of portal embolization by EIS and provide effective hematostasis.
authors: Department of Pediatrics, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
authors: Hironori
authors: H
authors: Sunakawa
authors: Daisuke
authors: D
authors: Tokuhara
authors: Akira
authors: A
authors: Yamamoto
authors: Satoshi
authors: S
authors: Sugimori
authors: Yoshiki
authors: Y
authors: Morotomi
authors: Shino
authors: S
authors: Taniguchi
authors: Masaharu
authors: M
authors: Nakaya
authors: Yuki
authors: Y
authors: Cho
authors: Katsutoshi
authors: K
authors: Matsui
authors: Saki
authors: S
authors: Kasuga
authors: Yukari
authors: Y
authors: Sakae
authors: Kazumi
authors: K
authors: Yamato
authors: Norifumi
authors: N
authors: Nishida
authors: Sadao
authors: S
authors: Tokimasa
authors: Haruo
authors: H
authors: Shintaku
mesh_terms: D002648:Child; D003131:Combined Modality Therapy; D004386:Duodenum / Q000098:blood supply*; D004621:Embolization, Therapeutic / Q000379:methods; D004724:Endoscopy; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery; D011183:Postoperative Complications; D015911:Sclerotherapy / Q000379:methods; D013157:Splenic Artery; D014648:Varicose Veins / Q000628:therapy*