Tavakkoli Hamid, Asadi Mehrnaz, Haghighi Mahshid, Esmaeili Abbas
Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
BMC Gastroenterol. 2006 Dec 27;6:43. doi: 10.1186/1471-230X-6-43.
One of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV) and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time.
We report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur.
Band ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.
上腔静脉综合征的罕见表现之一是“下行性”食管静脉曲张（DEV）出血，人们采用了不同方法来控制出血。本文报告了首例通过套扎术根除DEV的病例。
我们报告了一名42岁男性，他是白塞病患者。患者首次表现为因血栓形成导致的上腔静脉综合征，随后出现双相溃疡和关节痛。他接受了华法林、泼尼松龙和硫唑嘌呤治疗。患者的临床病程因一次呕血发作而复杂化，当时患者的凝血酶原时间（PT）在治疗范围内且无腹痛。经复苏并用新鲜冰冻血浆输血纠正PT后，进行了上消化道内镜检查。在食管上三分之一处可见明显的静脉曲张，向中部逐渐变细且无急性出血。胃和十二指肠正常。门静脉、肝静脉和脾静脉的彩色超声检查未发现血栓形成。进行了套扎术，患者出血未再复发。
对于存在无法纠正的基础疾病的患者，套扎术是控制DEV出血的一种安全有效的方法。
