jksr Journal of the Korean Society of Radiology J Korean Soc Radiol 1738-2637 2288-2928 The Korean Society of Radiology 10.3348/jksr.2020.81.1.231 jksr-81-231 Case Report Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report 0000-0001-6078-5020 ParkSe JinMD 1 0000-0002-2545-6923 KimYoung HwanMD 1 ∗ 0000-0002-4420-4836 KangUng RaeMD 1 0000-0002-1312-3072 JiSeung WooMD 2 Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea Department of Radiology, CHA Gumi Medical Center, CHA University, Gumi, Korea Corresponding author Young Hwan Kim, MD Department of Radiology, Daegu Catholic University College of Medicine,33 Duryugongwon-ro 17-gil, Nam-gu, Daegu 42472, Korea. Tel 82-53-650-4328 Fax 82-53-650-4339 E-mail yhkim68@cu.ac.kr 12020 712020 811 231236 08042019 22052019 03062019 Copyright © 2020 The Korean Society of Radiology 2020 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Duodenal varices can develop in patients with portal hypertension secondary to liver cirrhosis. Although upper gastrointestinal bleeding is often severe and fatal, the definite treatment or guideline has not been established. Although endoscopy is the primary therapeutic modality, the use of radiologic interventions, such as transjugular intrahepatic portosystemic shunt, balloon or vascular plug-assisted retrograde transvenous obliteration, and percutaneous transhepatic variceal obliteration, can be considered alternative treatment methods for duodenal varices. Herein, we report a case of duodenal varix in a patient with poor hepatic functional reserve and vascular anatomy, which are contraindications for an occlusion balloon or a vascular plug, successfully treated with coil-assisted retrograde transvenous obliteration.

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A 50-year-old woman with massive hematemesis. A. Endoscopy shows active bleeding from the duodenal varix (arrow). B. Axial contrast-enhanced computed tomography demonstrates a varix in the 3rd portion of the duodenum (white arrow) supplied by the inferior pancreaticoduodenal vein and draining into the right ovarian vein to form the mesocaval shunt (black arrow). C. Coronal contrast-enhanced computed tomography shows the mesocaval shunt formed by the inferior pancreaticoduodenal (white arrow) and right ovarian (black arrow) veins. D. Coil-assisted retrograde transvenous obliteration was successfully performed using a double microcatheter technique. Detachable coils were deployed in the ovarian vein through a more proximally placed microcatheter (arrow). E. Gelfoam mixed with a contrast agent was injected to embolize the duodenal varices (black arrow) and inferior pancreaticoduodenal vein (white arrow). F. Axial contrast-enhanced computed tomography obtained 6 months after coil-assisted retrograde transvenous obliteration shows complete obliteration of the duodenal varices (arrow).