Anegawa Go, Sumi Kenji, Miyoshi Atsushi, Kitahara Kenji, Satou Seiji
Department of Surgery, Saga-Ken Medical Centre Koseikan, 400 Kase-machi Nakabaru, Saga, 840-8571, Japan.
Surg Case Rep. 2016 Dec;2(1):65. doi: 10.1186/s40792-016-0192-z. Epub 2016 Jun 27.
Duodenal varices are a low-frequency cause of gastrointestinal bleeding; however, greater than 40 % mortality has been reported after the initial bleeding episode.
This report describes a 72-year-old woman with bleeding duodenal varices treated by surgery after failure of balloon-occluded retrograde transvenous obliteration (B-RTO). The patient presented with profuse melena. Emergent upper endoscopy was immediately performed, and bleeding duodenal varices in the second portion of the duodenum were seen. Endoscopic band ligation was attempted first followed by B-RTO; however, the combined procedures failed. Laparotomy under general anesthesia was then performed, and the venous collaterals were cannulated using an 18-gauge needle. Following intraoperative angiography, the venous collateral was ligated on the peripheral side of the needle entry point, and ethanolamine oleate was injected into the afferent collateral vessel. Endoscopic examination on postoperative day 4 showed embolization of the duodenal varices. The patient was discharged on postoperative day 11.
This technique is simple and effective, and we believe it is a potential alternative surgical treatment for duodenal varices with portal hypertension.
十二指肠静脉曲张是胃肠道出血的少见原因；然而，据报道初次出血发作后的死亡率超过40%。
本报告描述了一名72岁女性，其十二指肠静脉曲张出血，在球囊闭塞逆行静脉栓塞术（B-RTO）失败后接受了手术治疗。患者出现大量黑便。立即进行了急诊上消化道内镜检查，发现十二指肠第二部有出血性十二指肠静脉曲张。首先尝试内镜下套扎术，随后进行B-RTO；然而，联合治疗失败。然后在全身麻醉下进行剖腹手术，用18号针穿刺静脉侧支。术中血管造影后，在针穿刺点的外周侧结扎静脉侧支，并向传入侧支血管内注射油酸乙醇胺。术后第4天的内镜检查显示十二指肠静脉曲张已栓塞。患者于术后第11天出院。
该技术简单有效，我们认为它是门静脉高压性十二指肠静脉曲张潜在的替代手术治疗方法。
