Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report

Se Jin Park; Young Hwan Kim; Ung Rae Kang; Seung Woo Ji

doi:10.3348/jksr.2020.81.1.231

Journal List > J Korean Soc Radiol > v.81(1) > 1142000

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Park, Kim, Kang, and Ji: Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report

Case Report

J Korean Soc Radiol 2020;81(1):231-236.

Published online: 7 January 2020

DOI: https://doi.org/10.3348/jksr.2020.81.1.231

Successful Treatment of Duodenal Variceal Bleeding with Coil-Assisted Retrograde Transvenous Obliteration: A Case Report

Se Jin Park¹

, Young Hwan Kim^1,^∗

, Ung Rae Kang¹

, Seung Woo Ji²

¹Department of Radiology, Daegu Catholic University College of Medicine, Daegu, Korea

²Department 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

Received 8 April 201922 May 2019 Accepted 3 June 2019

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.

Index terms:

Index terms

Duodenum, Varix, Embolization, Therapeutic

REFERENCES

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Fig. 1.

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).

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