Juárez-Barrientos TE, Mejía-Loza S, García-Ruíz E, Zamarripa-Dorsey F

Language: Spanish
References: 26
Page: 180-183
PDF size: 236.87 Kb.

ABSTRACT

Introduction: Ectopic varices comprise large portosystemic venous collaterals located anywhere other than the gastro-oesophageal region. The Ectopic varices are common findings during endoscopy in portal hypertensive patients and their bleeding accounts for only 1-5% of all variceal bleeding. Case report: We report the case of a 60-year-old man with alcoholic cirrhosis and portal hypertension with a decrease in the caliber of the common bile duct, requiring therapeutic diagnostic ERCP in which a balloon catheter was introduced to corroborate the common bile duct’s perfusion presenting fatal intra-abdominal bleeding, so that it was surgically operated with a finding of multiple vessels of varicose neoplasia pericoledocianos and periduodenales. Electrocoagulation was performed, as well as the application of Gelfoam and Beriplast was performed for the treatment of duodenal varicose hemorrhage, because attempts to ligate varices by exploratory laparotomy were unsuccessful. Finally the patient dies of hypovolemic shock. Conclusion: Gallbladder variceal hemorrhage is a rare, but potentially catastrophic complication of cirrhosis. Management of this condition has been adapted from experience with esophagogastric varices, due to its low frequency.

REFERENCES

1. Akhter NM, Haskal ZJ. Diagnosis and management of ectopic varices. Gastrointest Interv 2012; 1(1): 3-10.

2. Sato T, Akaike J, Toyota J, Karino Y, Ohmura T. Clinicopathological features and treatment of ectopic varices with portal hypertension. Int J Hepatol 2011; 2011: 960720.

3. Kim MJ, Jang BK, Chung WJ, Hwang JS, Kim YH. Duodenal variceal bleeding after balloon-occluded retrograde transvenous obliteration: treatment with transjugular intrahepatic porto systemic shunt. World J Gastroenterol 2012; 18(22): 2877-80.

4. Khan AA, Sarwar S, Alam A, Butt AK, Shafgat F, Tarique S et al. Ectopic intestinal varices as a rare cause of lower gastrointestinal haemorrhage. J Coll Physicians Surg Pak 2003; 13(9): 526-7.

5. McAvoy NC, Plevris JN, Hayes PC. Human Thrombin for treatment of gastric and ectopic varices. World J Gastroenterol. 2012; 18(41): 5912-7.

6. Henry Z, Uppal D, Saad W, Caldwell S. Gastric and ectopic varices. Clin Liver Dis 2014; 18(2): 371-88.

7. Chu EC, Chick W, Hillebrand DJ, Hu KQ. Fatal spontaneous gallbladder variceal bleeding in a patient with alcoholic cirrhosis. Dig Dis Sci 2002; 47(12): 2682-5.

8. Sarin SK. Bhatia V, Makwana U. Portal biliopathy in extrahepatic portal venous obstruction. Indian J Gastroenterol 1992; 11: A82.

9. Khuroo MS, Yatoo GN, Zargar SA, Javid G, Dar MY, Khan BA et al. Biliary abnormalities associated with extrahepatic portal venous obstruction. Hepatology 1993; 17(5): 807-13.

10. Condat B, Vilgrain V, Asselah T, O’Toole D, Rufat P, Zappa M et al. Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography: a clinical and MR cholangiography coupled with MR portography imaging study. Hepatology 2003; 37(6): 1302-8.

11. Sezgin O1, Oğuz D, Altintaş E, Saritaş U, Sahin B. Endoscopic management of biliary obstruction caused by cavernous transformation of the portal vein. Gastrointest Endosc 2003; 58(4): 602-8.

12. Justo LA, Olcina JR, Tallón AG, Carbonell SP, Rivera JI, Vicente VM. Colangiopatía asociada a la hipertensión portal. Gastroenterol Hepatol 2011; 34(9): 619-23.

13. Wasler EM, Runyan BR, Heckman MG, Bridges MD, Willigham DL, Paz-Fumagalli R et al. Extrahepatic portal biliopathy: proposed etiology on the basis of anatomic and clinical features. Radiology 2011; 258(1): 146-53.

14. Akhter NM, Haskal ZJ. Diagnosis and management of ectopic varices. Gastrointest Interv 2012; 1(1): 3-10.

15. Sato T, Akaike J, Toyota J, Karino Y, Ohmura T. Clinicopathological features and treatment of ectopic varices with portal hypertension. Int J Hepatol 2011; 2011: 960720.

16. Kim MJ, Jang BK, Chung WJ, Hwang JS, Kim YH. Duodenal variceal bleeding after balloon-occluded retrograde transvenous obliteration: treatment with transjugular intrahepatic porto systemic shunt. World J Gastroenterol 2012; 18(22): 2877-80.

17. Khan AA, Sarwar S, Alam A, Butt AK, Shafgat F, Tarique S et al. Ectopic intestinal varices as a rare cause of lower gastrointestinal haemorrhage. J Coll Physicians Surg Pak 2003; 13(9): 526-7.

18. McAvoy NC, Plevris JN, Hayes PC. Human Thrombin for treatment of gastric and ectopic varices. World J Gastroenterol. 2012; 18(41): 5912-7.

19. Henry Z, Uppal D, Saad W, Caldwell S. Gastric and ectopic varices. Clin Liver Dis 2014; 18(2): 371-88.

20. Chu EC, Chick W, Hillebrand DJ, Hu KQ. Fatal spontaneous gallbladder variceal bleeding in a patient with alcoholic cirrhosis. Dig Dis Sci 2002; 47(12): 2682-5.

21. Sarin SK. Bhatia V, Makwana U. Portal biliopathy in extrahepatic portal venous obstruction. Indian J Gastroenterol 1992; 11: A82.

22. Khuroo MS, Yatoo GN, Zargar SA, Javid G, Dar MY, Khan BA et al. Biliary abnormalities associated with extrahepatic portal venous obstruction. Hepatology 1993; 17(5): 807-13.

23. Condat B, Vilgrain V, Asselah T, O’Toole D, Rufat P, Zappa M et al. Portal cavernoma-associated cholangiopathy: a clinical and MR cholangiography: a clinical and MR cholangiography coupled with MR portography imaging study. Hepatology 2003; 37(6): 1302-8.

24. Sezgin O1, Oğuz D, Altintaş E, Saritaş U, Sahin B. Endoscopic management of biliary obstruction caused by cavernous transformation of the portal vein. Gastrointest Endosc 2003; 58(4): 602-8.

25. Justo LA, Olcina JR, Tallón AG, Carbonell SP, Rivera JI, Vicente VM. Colangiopatía asociada a la hipertensión portal. Gastroenterol Hepatol 2011; 34(9): 619-23.

26. Wasler EM, Runyan BR, Heckman MG, Bridges MD, Willigham DL, Paz-Fumagalli R et al. Extrahepatic portal biliopathy: proposed etiology on the basis of anatomic and clinical features. Radiology 2011; 258(1): 146-53.