Sinjali Kiran, Bent Chris
University of California, Riverside School of Medicine, SOM Education Building, 900 University Ave, Riverside, CA, 92521 USA.
Department of Radiology, Riverside University Health System, 26520 Cactus Ave, Moreno Valley, CA 92555 USA.
Radiol Case Rep. 2021 Aug 26;16(11):3304-3307. doi: 10.1016/j.radcr.2021.08.002. eCollection 2021 Nov.
Duodenal variceal bleeding is a rare form of variceal bleeding which may be fatal if left untreated. There are no specific guidelines available for their treatment. Medical management, surgical, endoscopic, and interventional radiological procedures have been utilized with varied outcomes. In this case summary we report the successful management of duodenal variceal bleeding in a patient with prior Roux-en-Y gastric bypass . The patient with history of cirrhosis presented with acute gastrointestinal bleeding. Esophagogastroduodenoscopy and colonoscopy could not locate the source of bleeding. Computed tomography of the abdomen demonstrated a large duodenal variceal complex. Interventional radiology (IR) treated the patient with a combination of percutaneous transhepatic embolization and subsequent transjugular intrahepatic portosystemic shunt . No recurrence of gastrointestinal bleeding was noted at follow up. This case demonstrates that percutaneous transhepatic embolization along with transjugular intrahepatic portosystemic shunt may be effective treatment of duodenal variceal bleeding.
十二指肠静脉曲张出血是一种罕见的静脉曲张出血形式，若不治疗可能会致命。目前尚无针对其治疗的具体指南。药物治疗、手术、内镜及介入放射学程序均已应用，但效果各异。在本病例总结中，我们报告了一例既往接受过Roux-en-Y胃旁路手术的患者十二指肠静脉曲张出血的成功治疗。该肝硬化病史患者出现急性胃肠道出血。食管胃十二指肠镜检查和结肠镜检查均未找到出血源。腹部计算机断层扫描显示一个巨大的十二指肠静脉曲张复合体。介入放射学（IR）采用经皮经肝栓塞术联合随后的经颈静脉肝内门体分流术对该患者进行治疗。随访时未发现胃肠道出血复发。本病例表明，经皮经肝栓塞术联合经颈静脉肝内门体分流术可能是治疗十二指肠静脉曲张出血的有效方法。
