Palermo Monica, Santonocito Serafino, Failla Giovanni, Vacirca Francesco, Venturini Massimo, Palmucci Stefano, Basile Antonio
Radiology Unit 1, Department of Medical Surgical Sciences and Advanced Technologies "GF Ingrassia," University-Hospital Policlinico "G. Rodolico-S. Marco", University of Catania, Via S. Sofia, 95126, Catania, Italy.
Department of Diagnostic and Interventional Radiology, University of Insubria, Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
Radiol Case Rep. 2021 Apr 21;16(6):1580-1585. doi: 10.1016/j.radcr.2021.03.046. eCollection 2021 Jun.
Duodenal varices are ectopic varices that can cause severe and life-threatening gastrointestinal bleeding. Diagnosis and treatment of ectopic varices is challenging, because endoscopy is often unproductive in detecting and treating ectopic varices. Interventional radiology appears as an alternative in this setting, thanks to its important role in treating the bleeding caused by ectopic varices and in preventing rebleedings. We present an interesting case of bleeding ectopic varices in a male 62-years-old cirrhotic patient (Child-Pugh B8). The patient presented with hemorrhagic shock caused by massive melena. CT angiography showed intraluminal blood and identified the source of bleeding as an ectopic varicose vein draining into the superior mesenteric vein. Interventional radiology approach was the only applicable one to reach and effectively treat the source and cause of bleeding by TIPS placement and embolization of the collateral feeding at the same session.
十二指肠静脉曲张是一种异位静脉曲张，可导致严重且危及生命的胃肠道出血。异位静脉曲张的诊断和治疗具有挑战性，因为内镜检查在检测和治疗异位静脉曲张方面往往效果不佳。在这种情况下，介入放射学似乎是一种替代方法，这得益于其在治疗异位静脉曲张引起的出血以及预防再出血方面的重要作用。我们报告了一例有趣的病例，一名62岁的男性肝硬化患者（Child-Pugh B8级）出现出血性异位静脉曲张。患者因大量黑便导致失血性休克。CT血管造影显示管腔内有血液，并确定出血源为一条汇入肠系膜上静脉的异位曲张静脉。介入放射学方法是唯一适用的方法，可通过在同一次手术中放置经颈静脉肝内门体分流术（TIPS）和栓塞侧支供血来有效到达并治疗出血源及病因。
