Bhat Ambarish P, Davis Ryan M, Bryan William D
Department of Radiology, University of Missouri, Columbia, USA.
Indian J Radiol Imaging. 2019 Jul-Sep;29(3):313-317. doi: 10.4103/ijri.IJRI_21_19. Epub 2019 Oct 30.
Ectopic varices are complex and highly variable entities that are not fully understood. Duodenal varices from pancreatitis have rarely been reported. Ectopic varices have much higher bleeding rates than the more common gastro-esophageal varices, and are associated with higher mortality. The ideal management of this difficult problem is not only to ensure prompt hemostasis, but also address the etiology or hemodynamics of the ectopic varices. We discuss the endovascular management of bleeding duodenal varices, which developed from superior mesenteric vein occlusion, following repeated attacks of pancreatitis. This unusual case was managed by a multidisciplinary collaborative approach between the gastrointestinal service and Interventional radiology. The classification system for ectopic varices and management options has been discussed in some detail. Medium term follow-up (8 months), at the time of this writing, showed that the patient is doing well, without interval hematemesis, imaging findings of recurrent/new varices or stent occlusion.
异位静脉曲张是复杂且高度多变的实体，目前尚未被完全理解。胰腺炎所致的十二指肠静脉曲张鲜有报道。异位静脉曲张的出血率远高于更为常见的胃食管静脉曲张，且与更高的死亡率相关。对于这个难题的理想处理方式不仅要确保迅速止血，还要解决异位静脉曲张的病因或血流动力学问题。我们讨论了因胰腺炎反复发作导致肠系膜上静脉闭塞而引发的出血性十二指肠静脉曲张的血管内治疗。这个不寻常的病例通过胃肠科和介入放射科的多学科协作方法进行处理。文中已较为详细地讨论了异位静脉曲张的分类系统及处理选项。在撰写本文时的中期随访（8个月）显示，患者情况良好，没有间歇性呕血、复发性/新出现静脉曲张的影像学表现或支架闭塞。
