Haddad Anis, Beji Hazem, Chaker Youssef, Maghrebi Houcine, Jouini Mohamed, Kacem Montassar
Department of General Surgery A Hospital La Rabta Tunis, Tunisia.
Department of General Surgery A Hospital La Rabta Tunis, Tunisia.
Int J Surg Case Rep. 2021 Nov;88:106573. doi: 10.1016/j.ijscr.2021.106573. Epub 2021 Nov 3.
Bleeding from ileal varices is a rare and a life-threatening situation. Its management is difficult and includes endoscopic, surgical and interventional radiology treatment. Here we report a successful emergency surgery for bleeding ileal varices in a patient with cirrhosis due to autoimmune hepatitis.
A 60-year-old woman was admitted for rectal bleeding. She had a history of autoimmune hepatitis. She was treated by endoscopic ligation for oesophageal varices. Eso-gastro-duodenal fibroscopy and colonoscopy failed to reveal the bleeding site. CT scan was then performed showing ileal varices due to a portocaval shunt, there was a communication between the superior mesenteric vein and the right internal iliac vein. As the embolization was not feasible and the bleeding did not stop, an exploratory laparotomy was performed showing two dilated veins on the surface of the ileal wall, communicating with the right internal iliac vein. We performed a ligation of the vessels. Postoperative course was uneventful.
Ectopic varices are a rare case of gastrointestinal bleeding. Most of those patients have portal hypertension and liver cirrhosis. Diagnosing bleeding ileal varices is difficult because endoscopic examination can't always reveal the bleeding site. Interventional radiology is a good option for patients having bleeding ileal varices knowing that they often have advanced liver cirrhosis making them poor candidates for surgery. Haemostasis by endoscopy is often temporary and bleeding frequently recurs. Surgery should be considered if non-invasive treatments failed to ensure the haemostasis.
Bleeding ileal varices is a rare situation. Interventional radiology and endoscopy can be good options. If not feasible, surgical treatment should not be delayed.
回肠静脉曲张出血是一种罕见且危及生命的情况。其治疗困难，包括内镜、手术及介入放射学治疗。在此，我们报告一例因自身免疫性肝炎导致肝硬化的患者成功接受回肠静脉曲张出血急诊手术的病例。
一名60岁女性因直肠出血入院。她有自身免疫性肝炎病史。曾接受内镜下食管静脉曲张结扎术治疗。食管-胃-十二指肠纤维镜检查和结肠镜检查均未发现出血部位。随后进行CT扫描，显示因门静脉分流导致回肠静脉曲张，肠系膜上静脉与右髂内静脉之间存在交通支。由于栓塞不可行且出血不止，遂行剖腹探查术，发现回肠壁表面有两条扩张的静脉，与右髂内静脉相通。我们对血管进行了结扎。术后过程顺利。
异位静脉曲张是胃肠道出血的罕见病例。这些患者大多有门静脉高压和肝硬化。诊断回肠静脉曲张出血困难，因为内镜检查不一定能发现出血部位。对于回肠静脉曲张出血的患者，介入放射学是一个不错的选择，因为他们通常患有晚期肝硬化，不适合手术。内镜止血往往是暂时的，出血经常复发。如果非侵入性治疗未能确保止血，则应考虑手术治疗。
回肠静脉曲张出血是一种罕见情况。介入放射学和内镜检查可能是不错的选择。如果不可行，不应延迟手术治疗。
