scholarly journals “Downhill” Esophageal Varices due to Dialysis Catheter-Induced Superior Vena Caval Occlusion: A Rare Cause of Upper Gastrointestinal Bleeding

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Suresh Kumar Nayudu ◽  
Anil Dev ◽  
Kalyan Kanneganti
Keyword(s):  
Gastrointestinal Bleeding ◽  
Upper Gastrointestinal Bleeding ◽  
Superior Vena ◽  
Superior Vena Caval ◽  
Surgical Interventions ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion ◽  
Upper Gastrointestinal

“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding. Rarely these varices are reported in patients receiving hemodialysis as a complication of chronic dialysis vascular access. We present a case of acute upper gastrointestinal bleeding in an individual with end-stage renal disease receiving hemodialysis. Esophagogastroduodenoscopy revealed “downhill” varices in the upper third of the esophagus without any active bleeding at the time of the procedure. An angiogram was performed disclosing superior vena caval occlusion, which was treated with balloon angioplasty. Gastroenterologists should have a high index of suspicion for these rare “downhill” varices when dealing with acute upper gastrointestinal bleeding in patients receiving hemodialysis and manage it appropriately using endoscopic, radiological, and surgical interventions.

scholarly journals Risk factors for upper gastrointestinal bleeding among end-stage renal disease patients

2003 ◽  
Vol 64 (4) ◽  
pp. 1455-1461 ◽  
Author(s):  
Haimanot Wasse ◽  
Daniel L. Gillen ◽  
Adrianne M. Ball ◽  
Bryan R. Kestenbaum ◽  
Stephen L. Seliger ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Bleeding ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Upper Gastrointestinal Bleeding ◽  
Stage Renal Disease ◽  
End Stage ◽  
Upper Gastrointestinal

scholarly journals A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Lam-Phuong Nguyen ◽  
Narin Sriratanaviriyakul ◽  
Christian Sandrock
Keyword(s):  
Portal Hypertension ◽  
Superior Vena ◽  
Portal Pressure ◽  
Vena Cava ◽  
Acute Upper Gastrointestinal Bleeding ◽  
Extensive Evaluation ◽  
Intrahepatic Portosystemic Shunt ◽  
Stage Renal Disease ◽  
End Stage ◽  
High Index Of Suspicion

“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding and are generally due to obstruction of the superior vena cava (SVC). Often these cases of “downhill” varices are missed diagnoses as portal hypertension but fail to improve with medical treatment to reduce portal pressure. We report a similar case where recurrent variceal bleeding was initially diagnosed as portal hypertension but later found to have SVC thrombosis presenting with recurrent hematemesis. A 39-year-old female with history of end-stage renal disease presented with recurrent hematemesis. Esophagogastroduodenoscopy (EGD) revealed multiple varices. Banding and sclerotherapy were performed. Extensive evaluation did not show overt portal hypertension or cirrhosis. Due to ongoing bleeding requiring resuscitation, she underwent internal jugular (IJ) and SVC venogram in preparation for transjugular intrahepatic portosystemic shunt (TIPS), which demonstrated complete IJ and SVC occlusion. She underwent balloon angioplasty with stent placement across SVC occlusion with complete resolution of her varices and resolved hematemesis. “Downhill” varices are extremely rare, though previously well described. Frequently, patients are misdiagnosed with underlying liver disease. High index of suspicion and investigation of alternative causes of varices is prudent in those without underlying liver diseases. Prompt diagnosis and appropriate intervention can significantly improve morbidity and mortality.

scholarly journals Upper gastrointestinal bleeding in patients with end stage renal disease: causes, characteristics and factors associated with need for endoscopic therapeutic intervention

2017 ◽  
Vol 5 (2) ◽  
pp. 106-111 ◽  
Author(s):  
Syed Mudassir Laeeq ◽  
Abbas Ali Tasneem ◽  
Farina M. Hanif ◽  
Nasir Hassan Luck ◽  
Rajesh Mandhwani ◽  
...  
Keyword(s):  
Liver Disease ◽  
Gastrointestinal Bleeding ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Upper Gastrointestinal Bleeding ◽  
Factors Associated ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients ◽  
Upper Gastrointestinal

Abstract Background and Objectives The risk of upper gastrointestinal bleeding (UGIB) is increased among the end-stage renal disease (ESRD) patients. The aim of the current study was to describe the causes and characteristics of UGIB in ESRD patients at our center and to assess the need for endoscopic therapeutic intervention (ETI) using Rockall (RS) and Glasgow Blatchford scores (GBS). Material and Methods All patients with ESRD and UGIB with age ≥14 years were included. Frequencies and percentages were computed for categorical variables. Chi square test or Fischer’s exact test was used for statistical analysis. Results A total of 59 subjects had a mean age of 47.25 ± 15 years.The most common endoscopic findings seen were erosions in 33 (55.9%) patients, followed by ulcers in 18 (30.3%) patients. ETI was required in 33 (55.9%) patients, which included adrenaline injection in 19 (32.3%), hemoclip in 9 (15.2%) and argon plasma coagulation in 5 (8.4%) patients. Factors associated with the need of ETI were identified as: a combined presentation of hematemesis and melena (P=0.033), ulcer (P=0.002) and associated chronic liver disease (P=0.015). Six (10.1%) patients died. Death was more common if ETI was not performed (P=0.018). Conclusion ETI was more commonly required in patients on maintenance hemodialysis with UGIB, who had presence of combined hematemesis and melena, ulcers and associated chronic liver disease. A Glasgow Blatchford score of >14 was helpful in assessing the need for ETI in these patients.

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