Bleeding isolated jejunal varices

Main Article Content

Supamit Leemasawat

Abstract

          Bleeding isolated jejunal varices are rare, especially in patients without portal hypertension.


          This report presented a 51-year old male patient referred for intermittent massive hematochezia, without signs of cirrhosis or portal hypertension. Esophagogastroduodenoscopy and colonoscopy were negative for a source of bleeding. CT of the whole abdomen showed abnormal dilated intramural veins in the wall of the jejunum with dilated draining anti-mesenteric jejunal veins. Segmental resection of the affected jejunum was performed.

Article Details

Section
Case Report

References

Yuki N, Kubo M, Noro Y, Kasahara A, Hayashi N, Fusamoto H, et al. Jejunal varices as a cause of massive gastrointestinal bleeding. Am J Gastroenterol 1992;87 :514–7.

Kastanakis M, Anyfantakis D, Katsougris N, Bobolakis E. Massive gastrointestinal bleeding due to isolated jejunal varices in a patient without portal hypertension. Int J Surg Case Rep 2013;4:439-41

Lein BC, McCombs PR. Bleeding varices of the small bowel as a complication of pancreatitis: case report and review of the literature. World J Surg 1992;16:1147–9.

Koo SM, Jeong SW, Jang JY, Lee TH, Jeon SR, Kim HG, et al. Jejunal variceal bleeding successfully treated with percutaneous coil embolization. J Korean Med Sci 2012; 27: 321–4.

Eriguchi N, Aoyagi S, Hara M, Miyazaki T, Tanaka M, Toyonaga A. Jejunal varices as a cause of massive gastrointestinal bleeding – a case report. Kurume Med J 1998;45 :227–30.

Shiratori Y, Nakamura K, Ikeya T, Takagi K, Fukuda K. Hemostasis with endoscopic band ligation for rupture of jejunal varices. ACG Case Rep J 2019;6(9):e00211.

Heiberger CJ, Mehta TI, Yim D. Jejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage. BMJ Case Rep 2019;12(3): e228680.

Kuwahara T, Tokumitsu Y, Nakajima M, Matsukuma S, Matsui H, Shindo Y, et al. Two cases of rupture of elevated jejunal varices after operation for hilar cholangiocarcinoma. Gan To Kagaku Ryoho 2019;46:324-6.

Rostambeigi N, Shrestha P, Dunn TB, Golzarian J, Khoshnoodi P, Rosenberg M, et al. Recurrent ectopic variceal bleed after pancreas transplantation with no portal hypertension: case report and outcomes of endovascular onyx embolization. Vasc Endovascular Surg 2019;53:415-9.

Kohli DR, Levy MF, Smallfield GB. Laparotomy-assisted endoscopic injection of jejunal varices for overt small bowel bleeding. ACG Case Rep J 2017;4:e79.

Bass LM, Kim S, Superina R, Mohammad S. Jejunal varices diagnosed by capsule endoscopy in patients with post-liver transplant portal hypertension. Pediatr Transplant 2017;21(1):e12818.

el-Dosoky MM, Reeders JW, Dol JA, Tytgat GN. Familial intestinal varices without portal hypertension: a case report. Eur J Radiol 1994;18:140–1.

Cornman-Homonoff J, Madoff DC. Direct percutaneous access and coil embolization for management of recurrent jejuna variceal hemorrhage in the setting of a pre-existing TIPS. J Vasc Interv Radiol 2018;29:1626-29.

Abdalla AO, Abdallah MA, Calvo LA. Successful treatment of a case of ectopic jejunal varices with portal venous stenting. Am J Case Rep 2019;20:948-52.

Nishihara Y, Seyama Y, Takahashi M, Matsuoka Y, Kudo H, Kanomata H, et al. Portal venous stent placement for variceal hemorrhage in the elevated jejunum caused by portal vein stenosis after pancreatoduodenectomy: a case report. Nihon Shokakibyo Gakkai Zasshi 2019;116:249-55.

Lim LG, Lee YM, Tan L, Chang S, Lim SG. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. World J Gastroenterol 2009;15 :3823–6.

Helmy A, Al Kahtani KAl, Fadda MAI. Updates in the pathogenesis, diagnosis and management of ectopic varices. Hepatol Int 2008; 2: 322–34

Bhagwat SS, Borwankar SS, Ramadwar RH, Naik AS, Gajaree GI. Isolated jejunal varices. J Postgrad Med 1995;41 : 43–4.

Takashima K, Matsui S, Komeda Y, Nagai T, Toshiharu S, Kashida H, et al. Endoscopic sclerotherapy under balloon-assisted enteroscopy for hemorrhagic jejunal varices after choledocho-jejunostomy. Endoscopy 2020 ;52(2):E41-2.