A case of percutaneous transhepatic portal vein stent placement and endoscopic injection sclerotherapy for duodenal vari
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CASE REPORT
A case of percutaneous transhepatic portal vein stent placement and endoscopic injection sclerotherapy for duodenal variceal rupture occurring during chemotherapy for unresectable perihilar cholangiocarcinoma Koshiro Fukuda1 · Takashi Sasaki1 · Toshiaki Hirasawa2 · Kiyoshi Matsueda3 · Eisuke Nakao2 · Takafumi Mie1 · Takaaki Furukawa1 · Yuto Yamada1 · Tsuyoshi Takeda1 · Akiyoshi Kasuga1 · Masato Matsuyama1 · Masato Ozaka1 · Naoki Sasahira1 Received: 10 July 2020 / Accepted: 13 August 2020 © Japanese Society of Gastroenterology 2020
Abstract Duodenal varices are ectopic varices that are rare but can involve any site along the digestive tract outside the gastroesophageal region. Ectopic variceal bleeding is generally massive and life threatening; the mortality rate is approximately 40%. Up to 17% of ectopic varices occur in the duodenum. However, duodenal varices pose a significant therapeutic challenge due to the lack of standard treatment guidelines. We report a case of duodenal variceal bleeding secondary to portal vein stenosis in a 77-year-old woman receiving chemotherapy for unresectable perihilar cholangiocarcinoma. The patient presented with melena, nausea, vomiting and unstable vital signs suggestive of hemorrhagic shock. Emergency esophagogastroduodenoscopy revealed large nodular varices with a ruptured erosion on top in the superior duodenal angle, and variceal bleeding had stopped by the time of the procedure. Subsequent computed tomography showed the development of portosystemic collaterals; therefore, we performed percutaneous portal vein stent placement to reduce portal vein pressure. Since persistent bleeding was suspected, we also performed endoscopic injection sclerotherapy and achieved successful hemostasis with an improvement in liver function. This case revealed that a combination of portal vein stent placement and endoscopic injection sclerotherapy might be an effective therapy for duodenal variceal bleeding caused by portal vein stenosis. Keywords Duodenal varices · Portal vein stenosis · Portal hypertension · Portal vein stent placement · Endoscopic injection sclerotherapy Abbreviations EIS Endoscopic injection sclerotherapy Bpm Beats per minute Hb Hemoglobin * Naoki Sasahira [email protected] 1
Division of Hepato‑Biliary‑Pancreatic Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto, Tokyo 135‑8550, Japan
2
Division of Upper Gastrointestinal Medicine, Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto, Tokyo 135‑8550, Japan
3
Department of Diagnostic Imaging Medicine, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto, Tokyo 135‑8550, Japan
AST Aspartate aminotransferase ALT Alanine aminotransferase Alb Albumin EGD Esophagogastroduodenoscopy CT Computed tomography TIPS Transjugular intrahepatic portosystemic shunt B-RTO Balloon-occluded retrograde transven
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