Ruptured duodenal varices arising from the main portal vein successfully treated with endoscopic injection sclerotherapy: a case report

Korean J Hepatol. 2011 Jun;17(2):152-6. doi: 10.3350/kjhep.2011.17.2.152.

Abstract

Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cyanoacrylates / therapeutic use
  • Duodenal Diseases / diagnosis
  • Duodenal Diseases / etiology
  • Duodenal Diseases / therapy*
  • Duodenum / blood supply*
  • Endoscopy, Gastrointestinal
  • Gastrointestinal Hemorrhage / etiology
  • Gastrointestinal Hemorrhage / therapy*
  • Humans
  • Male
  • Middle Aged
  • Portal Vein
  • Rupture
  • Sclerosing Solutions / therapeutic use
  • Sclerotherapy*
  • Tomography, X-Ray Computed
  • Varicose Veins / complications
  • Varicose Veins / therapy*

Substances

  • Cyanoacrylates
  • Sclerosing Solutions