Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Dig Endosc. 2010 Oct;22(4):329-33. doi: 10.1111/j.1443-1661.2010.01023.x.
A 75-year-old man with general malaise and appetite loss was transferred to our hospital for assessment and treatment of liver failure. Laboratory findings on admission showed anemia, and gastroduodenoscopy (GDS) revealed linear esophageal varices and tensive duodenal varices (DV) in the second portion of the duodenum. Systemic examinations did not reveal any significant lesion capable of explaining his anemia, except for DV. Balloon-occluded retrograde transvenous obliteration was carried out to prevent DV bleeding. Good pooling of sclerosant was observed using two balloon catheters. However, contrast-enhanced computed tomography after the procedure revealed no thrombosis in DV, and the patient complained of tarry stools before additional therapy. Emergent GDS revealed ruptured DV with fresh blood and erosions on the surface. Emergent endoscopic obliteration using the tissue adhesive N-butyl-2-cyanoacrylate was carried out and complete hemostasis was achieved. Although no rebleeding episodes were observed after emergent obliteration, the patient died of sepsis following spontaneous bacterial peritonitis 53 days after admission. Autopsy revealed that DV dropped out, and the deep vein was replaced by granulation tissue. No signs of thrombi were detected, except varices. This autopsy case revealed the difficulty in DV management.
一位 75 岁男性，有全身不适和食欲减退，转至我院评估和治疗肝功能衰竭。入院时的实验室检查结果显示贫血，胃镜检查（GDS）显示食管静脉曲张呈线性，十二指肠第二段张力性十二指肠静脉曲张（DV）。全身检查除了 DV 外，没有发现任何能够解释他贫血的明显病变。为了防止 DV 出血，进行了球囊阻塞逆行经静脉闭塞术。使用两个球囊导管观察到硬化剂良好的积聚。然而，术后增强 CT 显示 DV 没有血栓形成，且患者在接受额外治疗前出现柏油样便。紧急 GDS 显示 DV 破裂，表面有新鲜血液和糜烂。使用组织胶 N-丁基-2-氰基丙烯酸酯进行紧急闭塞治疗，实现完全止血。尽管紧急闭塞后没有再出血，但患者在入院后第 53 天因自发性细菌性腹膜炎并发败血症死亡。尸检显示 DV 脱落，深静脉被肉芽组织取代。除了静脉曲张外，没有发现血栓的迹象。这个尸检病例揭示了 DV 管理的困难。
