Haq Inam -Ul-, Shah Amir Ali, Chandramohan S
Department of Gastroenterology and Hepatology, Crosshouse University Hospital, Kilmarnock, KA2 0BE, UK.
Department of Radiology, Queen Elizabeth University Hospital, 1345 Goven Road, Goven, Glasgow, UK G51 4TF.
J Coll Physicians Surg Pak. 2017 Mar;27(3):S11-S12.
Varices are abnormal dilated veins which result from increased pressure in the portal circulation. Although the oesophagus and stomach are the most common sites for varices to develop, they may also occur as ectopic varices in the duodenum, rectum, and retroperitoneal areas. Isolated duodenal varices involving distal duodenum, particularly the fourth part of the duodenum, are extremely rare. However, such ectopic varices are associated with an increased risk of bleeding and mortality. Not only are they a diagnostic challenge, particularly if they present as a first manifestation of portal hypertension, they are also very difficult to treat due to their location. We present an interesting case of upper gastrointestinal bleeding where ectopic varices in the fourth part of the duodenum presented as a first manifestation of upper gastrointestinal bleeding. Gastroscopy did not reveal the source of bleeding and thus CT angiogram was performed in order to confirm the diagnosis. Radiological intervention by embolisation resulted in successful treatment.
静脉曲张是由于门静脉循环压力升高导致的异常扩张静脉。尽管食管和胃是静脉曲张最常见的发生部位，但它们也可能以异位静脉曲张的形式出现在十二指肠、直肠和腹膜后区域。孤立性十二指肠静脉曲张累及十二指肠远端，尤其是十二指肠第四部，极为罕见。然而，这种异位静脉曲张与出血风险和死亡率增加相关。它们不仅是诊断上的挑战，特别是当它们作为门静脉高压的首发表现时，而且由于其位置关系，治疗也非常困难。我们报告一例有趣的上消化道出血病例，十二指肠第四部的异位静脉曲张是上消化道出血的首发表现。胃镜检查未发现出血源，因此进行了CT血管造影以确诊。通过栓塞进行的放射介入治疗取得了成功。
