Khor Vincent, Soon Yuen, Aung Lwin
MOH Holdings Singapore, 1 Maritime Square, #11-25 HarbourFront Centre, 099235, Singapore; Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, 609606, Singapore.
Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, 609606, Singapore.
Int J Surg Case Rep. 2018;49:205-208. doi: 10.1016/j.ijscr.2018.06.031. Epub 2018 Jun 28.
Ectopic variceal bleeding is uncommon, accounts for 2-5% of variceal bleeding, of which 17% is in duodenum.
62-year-old lady with newly diagnosed liver cirrhosis on admission, presented with severe upper gastrointestinal bleeding (UGIB), was ultimately diagnosed with bleeding duodenal varices with single-balloon enteroscopy, after multiple oesophagogastroduodenoscopies (OGDs) and CT scans which failed to identify the varices. She was treated successfully with duodenectomy.
Endoscopy and CT angiography remain the diagnostic modalities of choice. However, diagnosis can be difficult as evidenced by three OGDs and two CTMAs yielding negative findings in this case. Endoscopic diagnosis is challenging and often delayed due to its rarity and unusual location.
Ectopic variceal bleeding is a rare but important cause of UGIB. Diagnosis is challenging and management of this condition should take a multidisciplinary approach, involving experienced gastroenterologists, interventional radiologists and surgeons. Endoscopic ligation or sclerotherapy is the first-line of treatment.
异位静脉曲张出血并不常见，占静脉曲张出血的2%-5%，其中17%发生在十二指肠。
一名62岁女性入院时被新诊断为肝硬化，出现严重上消化道出血（UGIB），在多次食管胃十二指肠镜检查（OGD）和CT扫描均未能发现静脉曲张后，最终通过单气囊小肠镜诊断为十二指肠静脉曲张出血。她接受十二指肠切除术后成功治愈。
内镜检查和CT血管造影仍是首选的诊断方法。然而，本病例中三次OGD和两次CTMA均为阴性结果，表明诊断可能存在困难。由于其罕见性和不寻常的位置，内镜诊断具有挑战性且常常延迟。
异位静脉曲张出血是UGIB的一种罕见但重要的原因。诊断具有挑战性，对此病症的管理应采取多学科方法，包括经验丰富的胃肠病学家、介入放射科医生和外科医生。内镜结扎或硬化治疗是一线治疗方法。
