Hoshiai Akira, Tsurukiri Junya, Sumi Yasuhiro
Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo-Japan.
Ulus Travma Acil Cerrahi Derg. 2017 May;23(3):266-268. doi: 10.5505/tjtes.2016.01394.
Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult. Here we report a case of obscure gastrointestinal bleeding (GIB) due to ectopic varices in the small intestine that flowed into the inferior epigastric vein. Our observations suggest that when obscure GIB is detected in patients with either cirrhosis or post-surgical history including incisional hernia, it is essential to acquire multilanar reconstruction images and volume-rendered 3-dimensional reconstruction of computed tomography scans to investigate the complex venous supply and optimize decisions for therapy.
异位静脉曲张包括除食管或胃静脉曲张以外的所有静脉曲张，由腹部任何部位出现的大的门体静脉侧支组成。异位静脉曲张相对少见；然而，约5%与胃肠道出血有关。异位静脉曲张通常发生在直肠、十二指肠或结肠，门静脉高压是最常见的病因。异位静脉曲张的血流动力学特征尚不清楚，由于诊断和治疗困难，这些部位会发生大量出血。在此，我们报告一例因流入腹壁下静脉的小肠异位静脉曲张导致的不明原因胃肠道出血（GIB）病例。我们的观察结果表明，当在患有肝硬化或有包括切口疝在内的手术史的患者中检测到不明原因的GIB时，获取多层重建图像和计算机断层扫描的容积再现三维重建图像以研究复杂的静脉供血并优化治疗决策至关重要。
