Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization

Dong Hun Kang; Ji Won Park; Eui Yong Jeon; Sung Eun Kim; Jong Hyeok Kim; Young-Seok Kwon; Seung Ah Park; Choong Kee Park

doi:10.4166/kjg.2015.66.5.286

Journal List > Korean J Gastroenterol > v.66(5) > 1007445

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Kang, Park, Jeon, Kim, Kim, Kwon, Park, and Park: Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization

Case Report

Korean J Gastroenterol 2015;66(5):286-290.

Published online: 4 October 2015

DOI: https://doi.org/10.4166/kjg.2015.66.5.286

Successful Treatment of Bleeding Duodenal Varix by Percutaneous Transsplenic Embolization

Dong Hun Kang, Ji Won Park, Eui Yong Jeon¹, Sung Eun Kim, Jong Hyeok Kim, Young-Seok Kwon, Seung Ah Park, Choong Kee Park

Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea

¹Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea

Correspondence to: Ji Won Park, Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang 14068, Korea. Tel: +82-31-380-3710, Fax: +82-31-381-3724, E-mail: miunorijw@hallym.or.kr

Received 16 April 2015 Revised 9 June 2015 Accepted 10 June 2015

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

Variceal bleeding occurs primarily in the esophagus or stomach in patients with liver cirrhosis, but can also occur rarely in the duodenum. Duodenal variceal bleeding has a high mortality and poor prognosis due to heavy blood flow originating from the portal vein (PV) and the technical difficulty of hemostatic procedures. Treatments including endoscopic sclerotherapy, endoscopic ligations, endoscopic clipping and transjugular intrahepatic portosystemic shunt have been tried, with only moderate and variable success. A percutaneous transsplenic approach offers another way of accessing the PV. Here we report a case of successfully treated duodenal variceal bleeding by percutaneous transsplenic embolization.

Keywords: Duodenum, Varicose vein, Embolization

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Fig. 1.

(A) Upper gastroduodenoscopy shows a varix in the second portion of duodenum, with red spot. (B) Endo-scopic photograph shows the successfully band-ligated duodenal varix.

Fig. 2.

(A) On later endoscopy, post ligation ulceration was observed without bleeding sign. (B) There was no blood clot or trace of bleeding in other part of duodenum.

Fig. 3.

In the third portion of the duodenum, multiple dilated varices (arrow) were detected on contrast enhanced CT angiography.

Fig. 4.

(A) Under ultrasonographic and fluoroscopic guidance, transsplenic approach to the portal vein and duodenal varix (arrow) was done. (B) Selective and complete embolization of duodenal varix with glue was done using microcatheter.

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