Abstract
We report a case of successful embolization of jejunal varices that were the cause of massive gastrointestinal bleeding from a choledochojejunostomy site, resulting from obstruction of the extrahepatic portal vein. A 42-year-old man who had undergone choledochojejunostomy for intrahepatic and choledochal stones was readmitted after he started passing massive dark bloody stools. Gastrointestinal endoscopic examination and angiography could not identify the source of bleeding. Percutaneous transhepatic portography showed obstruction of the right branches of the portal vein. The formation of jejunal varices at the site of choledochojejunostomy was revealed by portography and by cholangioscopy, suggesting the varices as the cause of massive bleeding. Bleeding could not be controlled long-term by cholangioscopic sclerosing therapy. We finally stopped the bleeding by embolizing a jejunal vein to the afferent loop.
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Skarsgard E, Doski J, Jaksic T, Wesson D, Shandling B, Ein S, et al. Thrombosis of the portal venous system after splenectomy for pediatric hematologic disease. J Pediatr Surg 1993;28:1109–1112.
Ito T, Segawa T, Kanematsu T. Successful endoscopic injection sclerotherapy for bleeding from bile duct varices. Surg Today 1997;27:174–176.
Hiraoka K, Kondo S, Ambo Y, Hirano S, Omi M, Okushiba S, et al. Portal venous dilatation and stenting for bleeding jejunal varices: report of two cases. Surg Today 2001;31:1008–1011.
Miller JT Jr, De Odorico I, Marx MV. Cholecystojejunostomy varices demonstrated by enteroclysis. Abdom Imaging 1997;22:474–476.
Salam AA, Goldman M, Smith D Jr, Hill HL. Gastric, intestinal, and gallbladder varices: hemodynamic and therapeutic considerations. South Med J 1979;72:402–408.
Ito K, Kudo A, Nakamura N, Tanaka S, Teramoto K, Arii S. Left-side portal hypertension caused by serous cystadenoma of the pancreas: report of a case. Surg Today 2008;38:184–187.
Hamlyn AN, Morris JS, Lunzer MR, Puritz H, Dick R. Portal hypertension with varices in unusual sites. Lancet 1974;2:1531–1534.
Lein BC, McCombs PR. Bleeding varices of the small bowel as a complication of pancreatitis: case report and review of the literature. World J Surg 1992;16:1147–1149; discussion 1150.
Spira R, Widrich WC, Keusch KD, Jackson BT, Katzman HE, Coello AA. Bile duct varices. Arch Surg 1985;120:1194–1196.
Moncure AC, Waltman AC, Vandersalm TJ, Linton RR, Levine FH, Abbott WM. Gastrointestinal hemorrhage from adhesion-related mesenteric varices. Ann Surg 1976;183:24–29.
Joo YE, Kim HS, Choi SK, Rew JS, Kim HR, Kim SJ. Massive gastrointestinal bleeding from jejunal varices. J Gastroenterol 2000;35:775–778.
Zhao LQ, He W, Chen G. Characteristics of paraesophageal varices: a study with 64-row multidetector computed tomography portal venography. World Gastroenterol 2008;14:5331–5335.
Zhu H, Shi B, Upadhyaya M, Wu Z, Lin X, Wu Y, et al. Therapeutic endoscopy of localized gastric varices: pretherapy screening and posttreatment evaluation with MDCT portography. Abdom Imaging 2008;22:261–268.
Nakayama Y, Imuta M, Funama Y, Kadota M, Utunomiya D, Shiraishi S, et al. CT portography by multidetector helical CT: comparison of three rendering models. Radiat Med 2002;20:273–279.
Paquet KJ, Lazar A, Bickhart J. Massive and recurrent gastrointestinal hemorrhage due to jejunal varices in an afferent loop-diagnosis and management. Hepatogastroenterology 1994;41:276–277.
Chen VT, Wei J, Liu Y. A new procedure for management of extrahepatic portal obstruction. Arch Surg 1992;127:1358–1360.
Lautt WW, Greenway CV. Conceptual review of the hepatic vascular bed. Hepatology 1987;7:952–963.
Rocheleau B, Ethier C, Houle R, Huet PM, Bilodeau M. Hepatic artery buffer response following left portal vein ligation: its role in liver tissue homeostasis. Am J Physiol 1999;277:G1000–G1007.
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Sasamoto, A., Kamiya, J., Nimura, Y. et al. Successful embolization therapy for bleeding from jejunal varices after choledochojejunostomy: Report of a case. Surg Today 40, 788–791 (2010). https://doi.org/10.1007/s00595-009-4129-z
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DOI: https://doi.org/10.1007/s00595-009-4129-z