Liu Chantal, Srinivasan Sivasubramanian, Babu Suresh B, Chung Raymond
St George's Hospital Medical School, Cranmer Terrace, Tooting, London, SW17 0RE, UK.
Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore.
CVIR Endovasc. 2020 Mar 16;3(1):17. doi: 10.1186/s42155-020-00108-3.
Ectopic varices are uncommon and typically due to underlying liver cirrhosis. They can be located in the duodenum, small intestines, colon or rectum, and may result in massive haemorrhage. While established guidelines exist for the management of oesophageal and gastric variceal bleeding, this is currently lacking for colonic varices. Beta-blockers, transjugular intrahepatic portosystemic shunt insertion and subtotal colectomy have been reported as management methods. However, there are only two other cases that have reported successfully treating colonic varices using balloon-occluded retrograde transvenous obliteration (BRTO), an endovascular procedure typically performed for gastric varices.
A 55-year-old man with background of alcoholic liver cirrhosis presented with per-rectal bleeding due to caecal varices. Grade 2-3 oesophageal varices were identified on oesophago-gastro-duodenoscopy, and computed tomography showed multiple right para-colic portosystemic collaterals around the hepatic flexure and ascending colon. Colonoscopy confirmed fresh blood in the colon up to the caecum, with a submucosal varix deemed the most likely source of haemorrhage. As transjugular intrahepatic portosystemic shunt insertion was potentially technically difficult, due to left portal vein thrombosis and a small right portal venous system, he underwent BRTO, which successfully embolised and thrombosed the colonic varices without complications.
Whilst further studies are required to conclude its effectiveness and efficacy, BRTO may be considered a viable solution in managing ectopic, colonic, variceal haemorrhage especially when traditional techniques are unsuccessful or contraindicated.
异位静脉曲张并不常见，通常由潜在的肝硬化引起。它们可位于十二指肠、小肠、结肠或直肠，可能导致大量出血。虽然已有食管和胃静脉曲张出血的管理指南，但目前结肠静脉曲张方面尚缺乏此类指南。据报道，β受体阻滞剂、经颈静脉肝内门体分流术和结肠次全切除术为管理方法。然而，仅有另外两例报道成功使用球囊闭塞逆行静脉栓塞术（BRTO）治疗结肠静脉曲张，该血管内手术通常用于治疗胃静脉曲张。
一名55岁有酒精性肝硬化病史的男性因盲肠静脉曲张出现直肠出血。食管胃十二指肠镜检查发现2 - 3级食管静脉曲张，计算机断层扫描显示肝曲和升结肠周围有多个右侧结肠旁门体侧支循环。结肠镜检查证实结肠直至盲肠内有新鲜血液，一个黏膜下静脉曲张被认为是最可能的出血来源。由于左门静脉血栓形成且右门静脉系统较小，经颈静脉肝内门体分流术在技术上可能困难，因此他接受了BRTO，该手术成功栓塞并使结肠静脉曲张形成血栓，且无并发症。
虽然需要进一步研究以确定其有效性和疗效，但BRTO可被视为管理异位结肠静脉曲张出血的一种可行解决方案，尤其是在传统技术不成功或禁忌时。
