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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2019; 29(03): 313-317
DOI: 10.4103/ijri.IJRI_21_19
Case Report

A rare case of bleeding duodenal varices from superior mesenteric vein obstruction -treated with transhepatic recanalization and stent placement

Ambarish P Bhat
Department of Radiology, University of Missouri, Columbia, USA
,
Ryan M Davis
Department of Radiology, University of Missouri, Columbia, USA
,
William D Bryan
Department of Radiology, University of Missouri, Columbia, USA
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Ectopic varices are complex and highly variable entities that are not fully understood. Duodenal varices from pancreatitis have rarely been reported. Ectopic varices have much higher bleeding rates than the more common gastro-esophageal varices, and are associated with higher mortality. The ideal management of this difficult problem is not only to ensure prompt hemostasis, but also address the etiology or hemodynamics of the ectopic varices. We discuss the endovascular management of bleeding duodenal varices, which developed from superior mesenteric vein occlusion, following repeated attacks of pancreatitis. This unusual case was managed by a multidisciplinary collaborative approach between the gastrointestinal service and Interventional radiology. The classification system for ectopic varices and management options has been discussed in some detail. Medium term follow-up (8 months), at the time of this writing, showed that the patient is doing well, without interval hematemesis, imaging findings of recurrent/new varices or stent occlusion.

Keywords

Balloon-occluded antegrade transvenous obliteration - balloon-occluded retrograde transvenous obliteration - ectopic varices - endoscopic procedures - Gastrointestinal bleeding - pancreatitis - SMV recanalization - SMV stent - Transjugular intrahepatic porto-sytemic shunt


Publication History

Received: 08 January 2019

Accepted: 05 June 2019

Article published online:
22 July 2021

© 2019. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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