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Human thrombin for the treatment of gastric and ectopic varices

World Journal of Gastroenterology 2012年第41期18卷 5912-5917页

作者： Norma C McAvoy John N Plevris Peter C Hayes Department of Hepatology University of EdinburghRoyal Infirmary of EdinburghEdinburgh EH16 4SAUnited Kingdom

AIM:To evaluate the efficacy of human thrombin in the treatment of bleeding gastric and ectopic ***:Retrospective observational study in a Tertiary Referral *** January 1999-October 2005,we identified 37 patients who were endoscopically treated with human thrombin injection therapy for bleeding gastric and ectopic *** details including age,gender and aetiology of liver disease/segmental portal hypertension were *** thrombin was obtained from the Scottish National Blood Transfusion Service and prepared to give a solution of 250 IU/mL which was injected via a standard injection *** patient case notes were reviewed and the total dose of thrombin given along with the number of endoscopy sessions was *** haemostasis rates,rebleeding rates and mortality were catalogued along with the incidence of any immediate complications which could be attributable to the thrombin *** duration of follow up was also *** study was conducted according to the United Kingdom research ethics ***:Thirty-seven patients were included.33 patients(89%) had thrombin(250 U/mL) for gastric varices,2(5.4%) for duodenal varices,1 for rectal varices and 1 for gastric and rectal varices.(1) Gastric varices,an average of 15.2 mL of thrombin was used per ***-bleeding occurred in 4 patients(10.8%),managed in 2 by a transjugular intrahepatic portosystemic shunt(TIPSS)(one unsuccessfully who died) and in other 2 by a distal splenorenal shunt;(2) Duodenal varices(or type 2 isolated gastric varices),an average of 12.5 mL was used per patient over 2-3 endoscopy ***-bleeding occurred in one patient,which was treated by TIPSS;and(3) Rectal varices,an average of 18.3 mL was used per patient over 3 endoscopy *** re-bleeding occurred in this ***:Human thrombin is a safe,easy to use and effective therapeutic option to control haemorrhage from gastric and ectopic varices.

关键词： Variceal haemorrhage ectopic varices Gastric varices, Portal hypertension Thrombin

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Transjugular intrahepatic portosystemic shunt for repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices: A case report

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Journal of Interventional Medicine 2020年第3期3卷 157-160页

作者： Qin Shi Chen Zhou Jiacheng Liu Kun Qian Yiming Liu Songlin Song Bin Xiong Department of Radiology Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430022China Hubei Province Key Laboratory of Molecular Imaging Wuhan430022China

Background:Severe portal hypertension is life-threatening and can bring adverse complications such as ascites,gastroesophageal varices,and *** can,even cause variceal hemorrhage,which may lead to a high risk of *** is a rare incidence in bleeding of hemorrhoids caused by severe ectopic *** presentation:We report the case of a female patient with a 20-year history of hepatitis B virus infection who presented with repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices that is connection between the superior mesenteric vein and rectal venous *** results revealed a hemoglobin level of 74 g/***,the patient was successfully treated with transjugular intrahepatic portosystemic shunt(TIPSS)placement without variceal embolization after a multidisciplinary comprehensive *** the two-month follow-up period,the patient had failed to develop hepatic encephalopathy or hematochezia,and computed tomography venography(CTV)indicated that the stent was unobstructed and ascites ***:TIPSS placement is effective for the case,and we hope this case can help improve clinicians’awareness of hemorrhoidal bleeding with severe portal *** hypertension should also be considered during the diagnosis and treatment,as opposed to hemorrhoidal bleeding ***,abdominal CTV is recommended as an effective imaging examination method to determine the stent status after operation.

关键词： Hemorrhoidal bleeding ectopic varices Portal hypertension Transjugular intrahepatic portosystemic shunt

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Hemorrhagic ascites from spontaneous ectopic mesenteric varices rupture in NASH induced cirrhosis and successful outcome:A case report

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World Journal of Gastroenterology 2014年第25期20卷 8292-8297页

作者： Raja GR Edula Kamran Qureshi Hicham Khallafi Department of Medicine Division of Gastroenterology and HepatologyRutgers New Jersey Medical SchoolNewarkNJ 07103United States Department of Hepatology Florida Hospital Transplant CenterOrlando FL 32804United States

Bleeding from gastro-esophageal varices can often present as the first decompensating event in patients with cirrhosis. This can be a potentially life threatening event associated with a 15%-20% early mortality. We present a rare case of new onset ascites due to intra-abdominal hemorrhage from ruptured mesenteric varices; in a 37 years old male with newly diagnosed nonalcoholic steatohepatitis induced cirrhosis as the first decompensating event. The patient was successfully resuscitated with emergent evacuation of ascites for diagnosis, identification and control of bleeding mesenteric varices and eventually orthotopic liver transplantation with successful outcome. Various clinical presentations, available treatment options and outcomes of ectopic variceal bleeding are discussed in this report.

关键词： Cirrhosis Nonalcoholic steatohepatitis ectopic varices Hemorrhagic ascites Portal hypertension Orthotopic liver transplantation

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Duodenal giant stromal tumor combined with ectopic varicose hemorrhage:A case report

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World Journal of Clinical Cases 2020年第23期8卷 6009-6015页

作者： Da-Huan Li Xue-Ying Liu Liang-Bi Xu Center of Digestive Endoscopy The Affiliated Hospital of Guizhou Medical UniversityGuiyang 550000Guizhou ProvinceChina Department of Gastroenterology Guizhou Medical UniversityGuiyang 550000Guizhou ProvinceChina

BACKGROUND Gastrointestinal stromal tumors(GISTs)are mesenchymal tissue tumors originating from Cajal cells,presenting diverse clinical manifestations due to the different sizes,locations,and growth patterns of the *** is an uncommon site of GISTs,more with gastrointestinal obstruction and bleeding as the first *** duodenal varix,as a rare varix occurring outside the gastroesophageal region,is the main type of heterotopic varices and an unusual cause of gas-trointestinal *** etiology is mainly seen in liver cirrhosis,portal hypertension,vasculitis,portal vein embolism and obstruction caused by various *** of duodenal stromal tumor combined with ectopic variceal hemorrhage are rarely seen;however,when it occurs,the situation can sometimes be urgent and life-threatening,especially when traditional endoscopy and imaging fail to detect the lesion *** SUMMARY We report a 52-year-old female patient who had no obvious inducement to develop black *** in a local hospital revealed that the duodenal horizontal ectopic varices were ruptured and *** metal clamping hemostasis,she still had gastrointestinal bleeding and was transferred to our *** showed that active bleeding was still seen in the horizontal part of duodenum,and suspicious submucosal eminence was seen in the bleeding *** computed tomography showed a huge stromal tumor of duodenum,specimens were pathologically confirmed after *** a 3-mo follow-up,no gastrointestinal hemorrhage and complications *** ectopic variceal hemorrhage is rare but sometimes *** may be combined with stromal tumor,which can be diagnosed by multiple *** and surgical treatment are effective.

关键词： Duodenal stromal tumor ectopic varices Gastrointestinal hemorrhage Endoscopic therapy Surgical operation Case report

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Variceal bleeding from ileum identified and treated by single balloon enteroscopy

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World Journal of Gastroenterology 2009年第15期15卷 1904-1905页

作者： Mario Traina Ilaria Tarantino Luca Barresi Filippo Mocciaro Gastroenterology Department ISMETT/UPMC Department of Internal MedicineO.V.Cervello

We report a case of acute uncontrolled gastrointestinal bleeding in a patient with liver *** upper and lower endoscopy were negative for bleeding lesions. We decided to perform the examination of the small bowel using single-balloon *** lower enteroscopy revealed signs of bleeding from varices of the *** this report,we showed that the injection of a sclerosant solution can be accomplished using a freehand technique via the single balloon enteroscopy.

关键词： ectopic varices Ileal bleeding Enteroscopy Portal hypertension Glue injection

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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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