Bhardwaj Richa, Bhardwaj Gaurav, Bee Erik, Karagozian Raffi
Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA.
Department of Gastroenterology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA.
BMJ Case Rep. 2017 Aug 16;2017:bcr-2017-221200. doi: 10.1136/bcr-2017-221200.
Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%-5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign. TIPSS was performed and portogram revealed a single DV. Poststent placement venogram revealed a persistent varix and hence a 5-7 mm MVP was deployed. Subsequent imaging showed cessation of blood through the DV. The patient had no further bleeding. TIPSS with embolisation is an effective treatment for ECV. This MVP offers advantages due to its size and compatibility and can be redeployed in case of suboptimal placement.
异位静脉曲张（ECV）发生在常见静脉曲张部位以外的胃肠道（GI），占所有胃肠道静脉曲张出血的2%-5%，死亡率高达40%。由于难以接近和再出血风险增加，管理具有挑战性。我们报告了据我们所知首次将一种新型微血管栓塞物（MVP）与经颈静脉肝内门体分流术（TIPSS）联合用于十二指肠静脉曲张（DV）出血的临床应用。一名68岁男性出现黑便。内镜检查显示十二指肠第二部有II级静脉曲张，有红色条纹征。进行了TIPSS，门静脉造影显示单一的DV。放置支架后的静脉造影显示静脉曲张持续存在，因此部署了一个5-7毫米的MVP。随后的影像学检查显示通过DV的血流停止。患者未再出血。TIPSS联合栓塞术是治疗ECV的有效方法。这种MVP因其尺寸和兼容性具有优势，并且在放置不理想的情况下可以重新部署。
