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Treatment of colonic varices and gastrointestinal bleeding by recanalization and stenting of splenic-vein-thrombosis:A case report and literature review

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World Journal of Gastroenterology 2023年第24期29卷 3922-3931页

作者： Lisa-Michaela Füssel Rene Müller-Wille Patrick Dinkhauser Walter Schauer Harald Hofer Department of Internal Medicine Ⅰ Gastroenterology and HepatologyKlinikum Wels-GrieskirchenWels 4600Austria Department of Radiology Klinikum Wels-GrieskirchenWels 4600Austria Department of Abdominal Surgery Klinikum Wels-GrieskirchenWels 4600Austria

BACKGROUND Splenic vein thrombosis is a known complication of *** can lead to increased blood flow through mesenteric *** segmental hypertension may result in the development of colonic varices(CV)with a high risk of severe gastrointestinal *** clear guidelines for treatment are lacking,splenectomy or splenic artery embolization are often used to treat *** vein stenting has been shown to be a safe *** SUMMARY A 45-year-old female patient was admitted due to recurrent gastrointestinal *** was anemic with a hemoglobin of 8.0 g/*** a source of bleeding,CV were *** tomography scans revealed thrombotic occlusion of the splenic vein,presumably as a result of a severe acute pancreatitis 8 years *** a selective angiography,a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be *** hepatic venous pressure gradient was within normal *** an interdisciplinary board,transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting,as well as coiling of the aberrant veins was discussed and successfully *** evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during *** Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to ***,a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

关键词： Pancreatitis-induced splenic vein thrombosis Gastrointestinal hemorrhage colonic varices Splenic vein stenting Segmental/sinistral hypertension Case report

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Ectopic Ascending colonic Variceal Bleeding Treated with Balloon-Occluded Retrograde Transvenous Obliteration in a Decompensated Liver Cirrhosis Patient—A Hepatology Perspective

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Case Reports in Clinical Medicine 2020年第7期9卷 191-200页

作者： Gim Hin Ho Suresh Babu Chern Hao Chong Constantinos P. Anastassiades Division of Gastroenterology Department of Medicine Khoo Teck Puat Hospital Singapore Department of Diagnostic Radiology Interventional Radiology Khoo Teck Puat Hospital Singapore Gut Care Digestive Liver Endoscopy Associates Singapore Division of Gastroenterology and Hepatology Department of Medicine National University Hospital Singapore

Ectopic colonic varices development from liver cirrhosis and portal hypertension is uncommon. They are part of the spectrum of portal hypertensive colopathy. colonic variceal bleeding remains a rare cause of lower gastrointestinal tract (GI) bleeding. Due to the paucity of cases, there are no well-established conventional treatments for bleeding colonic varices. Different treatments have been reported. Here, we report a case of a 55-year-old gentleman, with a history of alcoholic liver cirrhosis, presenting with severe lower GI bleeding and symptomatic anaemia. An esophagogastroduodenoscopy revealed large esophageal varices with high-risk bleeding stigmata requiring endoscopic variceal ligation. A cross-sectional computed tomography scan showed colonic portosystemic shunts. In light of this and that the severe lower GI bleeding seemed out of proportion to the esophageal varices seen on upper endoscopy, an urgent unprepped colonoscopy was performed which revealed possible bleeding diverticula disease which required endoscopic mechanical hemoclip therapy. However, despite this, patient had recurrence of lower GI bleeding prompting a second colonoscopy. This relook colonoscopy showed ectopic ascending colon varices with high-risk bleeding stigmata. High-dose intravenous vasoactive agent somatostatin (500 mcg/hour) and subsequently terlipressin (2 mg every 4 hours) were used. The patient subsequently underwent successful balloon-occluded retrograde transvenous obliteration (B-RTO) and sclerotherapy. The non-selective beta-blocker (NSBB) carvedilol was started and bridged together with the vasoactive agent until stabilisation of portal hypertension. This difficult case illustrates the dynamic nature of portal hypertensive bleeding. It also highlights the presence of confounding non-variceal pathology complicating diagnosis of portal hypertensive colonic variceal bleeding, and that ectopic ascending colonic variceal bleeding can be treated successfully with B-RTO and scle

关键词： Ectopic varices colonic varices Portal Hypertension Balloon-Occluded Retrograde Transvenous Obliteration Sclerotherapy Liver Cirrhosis

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