title: Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension.
abstract: Portal hypertension secondary to portal vein obstruction following liver transplant occurs in 5%-10% of children. Jejunal varices are uncommon in this group. We present a case series of children with significant GI blood loss, negative upper endoscopy, and jejunal varices detected by CE. Case series of patients who had CE for chronic GI blood loss following liver transplantation. Three patients who had their initial transplants at a median age of 7 months were identified at our institution presenting at a median age of 8 years (range 7-16 years) with a median Hgb of 2.8 g/dL (range 1.8-6.8 g/dL). Upper endoscopy was negative for significant esophageal varices, gastric varices, and bleeding portal gastropathy in all three children. All three patients had significant jejunal varices noted on CE in mid-jejunum. Jejunal varices were described as large prominent bluish vessels underneath visualized mucosa, one with evidence of recent bleeding. The results led to venoplasty of the portal vein in two patients and a decompressive shunt in one patient with resolution of GI bleed and anemia. CE is useful to diagnose intestinal varices in children with portal hypertension and GI bleeding following liver transplant.
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Lee M
authors.initials: LM
authors.lastname: Bass
authors.affiliation: Department of Radiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Kim
authors.affiliation: Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Superina
authors.affiliation: Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mohammad
mesh_terms: D000293:Adolescent; D053704:Capsule Endoscopy; D002648:Child; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000175:diagnosis*; D007583:Jejunum / Q000098:blood supply*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications
chemical_list: D006454:Hemoglobins
keywords: GI bleeding; capsule endoscopy; jejunal varices; portal hypertension