scholarly journals Percutaneous Transhepatic Embolization of Ectopic Varices in a Patient With Portal Hypertension Presenting With Hemorrhagic Shock

Cureus ◽  
2021 ◽  
Author(s):  
Zachary Ohs ◽  
Matthew Jones ◽  
Neil Sharma ◽  
Kristian Loveridge
Keyword(s):  
Portal Hypertension ◽  
Hemorrhagic Shock ◽  
Ectopic Varices

scholarly journals Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

2019 ◽  
Vol 03 (03) ◽  
pp. 214-226
Author(s):  
Alexander Dabrowiecki ◽  
Eric J. Monroe ◽  
Rene Romero ◽  
Anne E. Gill ◽  
C. Matthew Hawkins
Keyword(s):  
Portal Hypertension ◽  
Small Bowel ◽  
Endovascular Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Percutaneous Treatment ◽  
Roux Limb ◽  
Case Review ◽  
Gastroesophageal Varices ◽  
Ectopic Varices

AbstractPortal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

Role of Endoscopic Ultrasound to Assess and Manage Portal Hypertension

2020 ◽  
Vol 04 (02) ◽  
pp. 103-109
Author(s):  
Sidhant Singh ◽  
Saurabh Mukewar
Keyword(s):  
Portal Hypertension ◽  
Gastrointestinal Tract ◽  
Endoscopic Ultrasound ◽  
Portal Pressure ◽  
Pressure Measurements ◽  
Vascular Changes ◽  
Ectopic Varices ◽  
Portal Venography ◽  
Intrahepatic Shunt

AbstractPortal hypertension leads to the development of varices along the gastrointestinal tract. Endoscopy plays an important role in the diagnosis and management of varices. Endosonography (EUS) enables visualization and permits access to varices and veins outside the gastrointestinal tract. EUS has emerged as an important tool, with the ability to identify vascular changes, treat gastric and ectopic varices, perform portal pressure measurements, portal venography, and intrahepatic shunt placement. This review discusses the role of endoscopy and the emerging role of EUS in evaluation and management of portal hypertension.

scholarly journals A73 PHARYNGEAL VARICES AS A COMPLICATION OF PORTAL HYPERTENSION: A CASE SERIES

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 86-88
Author(s):  
J Ghaith ◽  
P James ◽  
F Wong
Keyword(s):  
Portal Hypertension ◽  
Portal Vein ◽  
Esophageal Varices ◽  
Splenic Vein ◽  
Case Series ◽  
Brachiocephalic Vein ◽  
Splenic Vein Thrombosis ◽  
Vein Thrombosis ◽  
Ectopic Varices ◽  
Collateral Vessels

Abstract Background One of the complications of portal hypertension, with or without the presence of cirrhosis, is the development of varices along the length of the gastrointestinal tract. The commonest sites are along the esophagus or in the stomach. Ectopic varices in the small and large bowels can also be observed, but ectopic varices in the pharynx are extremely uncommon. Aims To present a case series and review the literature regarding pharyngeal varcies. Methods - Results Three elderly female patients presented for esophagogastric varices surveillance gastroscopy were diagnosed with pharyngeal varices. One patient has hepatitis C cirrhosis, while the other two non-cirrhotic patients have myeloproliferative neoplasm (MPN). None of the patients had thromboses of the portal vein or its tributaries. All three patient have concomitant esophageal varices, but only one required band ligation of her esophageal varices. All patients are asymptotic except for mild dysphagia. No patient has bled from their pharyngeal varices to date. Two patients have had prophylactic treatment of their portal hypertension with non-selective beta blocker (NSBB), while the third one has not received NSBB prophylaxis because of her age. Conclusions Pharyngeal varices are extremely rare. To date, there are three case reports in the literature, however, we have been able to identify three cases in our practice. The previous two cases reported possible left-sided portal hypertension with splenic vein thrombosis, leading to the development of collateral vessels including a gastrocaval shunt, which by some contiguous route connects to the brachiocephalic vein; and a third case was a complication of neck dissection surgery. In our case series, none of our patients had splenic vein thrombosis. However, none of them has had a careful CT angiogram to delineate the portal vein tributaries and the collateral vessels, which may further help to define their pathogenesis. It is unclear whether NSBB would be effective as primary prophylaxis against their bleeding, The plan is to continue to monitor these patients to learn about the natural history of these pharyngeal varices. Funding Agencies None

scholarly journals A174 RARE BUT DEADLY: AN APPROACH TO MANAGEMENT OF DUODENAL VARICEAL HEMORRHAGE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 39-41
Author(s):  
M Dahiya ◽  
M Tomaszewski ◽  
G Ou ◽  
A Ramji
Keyword(s):  
Interventional Radiology ◽  
Case Report ◽  
Portal Hypertension ◽  
Literature Review ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Cyanoacrylate Glue ◽  
Duodenal Varices ◽  
Ectopic Varices

Abstract Background Common etiologies of upper gastrointestinal bleeding (UGIB) in cirrhotic patients with portal hypertension include gastroesophageal varices (GOV), portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). Less commonly, patients with portal hypertension develop varices in ectopic sites, including the rectum, biliary tree and duodenum. Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Aims To describe the management of duodenal variceal hemorrhage. Methods A case report and literature review was performed. Results Case report: We present a case of recurrent UGIB in a 59-year-old male with decompensated cirrhosis due to non-alcoholic steatohepatitis (CP-C; Meld 14). Initial endoscopy was negative for GOV, peptic ulcer, PHG, and GAVE, but an erosion over a mucosal bulge in the third segment of the duodenum was identified, raising possibility of vascular malformation versus ectopic varix. There was active bleeding after water provocation, so clips were deployed for hemostasis. CT imaging showed mesenteric venous collaterals abutting the duodenum, again raising possibility of duodenal varix, which was ultimately confirmed by endoscopic ultrasound (EUS). Patient had recurrent overt bleeding despite beta-blockage for prophylaxis, endoscopic clipping on four separate occasions, attempted angioembolization by interventional radiology, and cyanoacrylate glue. Transjugular intrahepatic porto-systemic shunt (TIPS) was not possible due to portal vein occlusion, so he underwent EUS-guided cyanoacrylate glue a second time. Literature review: Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Duodenal variceal hemorrhage can lead to hemorrhagic shock, and is potentially life threatening, with quoted mortality rates of 40%. Unfortunately, duodenal varices can be difficult to identify. Diagnosis is often delayed due to a combination of lower awareness and endoscopic challenges given the unusual serosal and submucosal location. Evidence-based guidelines for the management of ectopic varices are limited. For this reason, our current management strategies rely heavily on local expertise. Splanchnic vasoconstrictor medication, endoscopic ligation, EUS guided gluing, interventional radiology guided embolization, TIPS, balloon retrograde transvenous obliteration and surgical shunts are potential therapeutic options to manage the acutely bleeding varix. Following a variceal bleed, liver transplantation should be considered in eligible patients with no other contraindications. Conclusions Duodenal varices are a rare, potentially fatal, and underrecognized cause of gastrointestinal bleeding in patients with portal hypertension. Definitive therapy currently relies upon local expertise in the absence of clear guideline-based therapy. Funding Agencies None

Transjugular intrahepatic portosystemic shunt in the treatment of ectopic varices secondary to portal hypertension

2003 ◽  
Vol 124 (4) ◽  
pp. A665
Author(s):  
Ramasamy Saravanan ◽  
Manu Nayar ◽  
Peter Rowlands ◽  
Richard Mc Williams ◽  
Howard Smart ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Transjugular Intrahepatic Portosystemic Shunt ◽  
Portosystemic Shunt ◽  
Ectopic Varices ◽  
Intrahepatic Portosystemic Shunt

scholarly journals Bleeding Ectopic Varices as the First Manifestation of Portal Hypertension

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Brij Sharma ◽  
Sujeet Raina ◽  
Rajesh Sharma
Keyword(s):  
Portal Hypertension ◽  
Upper Gastrointestinal Bleeding ◽  
Venous Obstruction ◽  
Gastroesophageal Varices ◽  
Upper Gi ◽  
Ectopic Varices ◽  
Extrahepatic Portal Venous Obstruction ◽  
Portosystemic Collateral ◽  
Upper Gi Endoscopy ◽  
Upper Gastrointestinal

Ectopic varices are defined as dilated portosystemic collateral veins in locations other than the gastroesophageal region. We present a case of recurrent upper gastrointestinal bleeding as the first manifestation of portal hypertension. We diagnosed ectopic duodenal varices without gastroesophageal varices on upper GI endoscopy and extrahepatic portal venous obstruction (EHPVO) on CT angiography and managed this case.

scholarly journals Isolated Ascending Colon Varix: An Unusual Cause of Lower Gastrointestinal Bleed

2021 ◽  
Vol 12 (02) ◽  
pp. 116-117
Author(s):  
Jahnvi Dhar ◽  
Jayanta Samanta ◽  
Gaurav Muktesh ◽  
Rakesh Kochhar
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Therapy ◽  
Gastroesophageal Junction ◽  
Clinical Suspicion ◽  
Rare Entity ◽  
Ascending Colon ◽  
Gastrointestinal Bleed ◽  
Ectopic Varices ◽  
Lower Gastrointestinal Bleed ◽  
The Common

AbstractEctopic varices, defined as dilated portosystemic veins located at unusual sites other than the gastroesophageal junction and fundus, have been reported in cases of cirrhosis with underlying portal hypertension. The common sites usually are the rectum and duodenum. Isolated colon varix is therefore a rare phenomenon and such varix presenting with lower gastrointestinal bleed as the first manifestation is still uncommon. A high index of clinical suspicion, timely imaging with full-length colonoscopy, and subsequent endoscopic therapy can effectively manage this rare entity.

scholarly journals Ectopic Variceal Bleeding From Chronic Superior Mesenteric Vein Thrombosis After Hemorrhagic Pancreatitis

2021 ◽  
Author(s):  
Kathryn Flynn ◽  
Kevin Chung ◽  
Thomas Brooke ◽  
Jonathan Keung
Keyword(s):  
Portal Hypertension ◽  
Superior Mesenteric Vein ◽  
Common Cause ◽  
Mesenteric Vein Thrombosis ◽  
Mesenteric Vein ◽  
Vein Thrombosis ◽  
Hemorrhagic Pancreatitis ◽  
The Third ◽  
Ectopic Varices ◽  
Superior Mesenteric Vein Thrombosis

Varices are a common cause of gastrointestinal bleed, but a small percentage of these bleeds are due to ectopic varices. This case presents bleeding ectopic varices in the third part of the duodenum with portal hypertension secondary to chronic superior mesenteric vein thrombosis that developed after hemorrhagic pancreatitis.

scholarly journals Duodenal Varices: A Rare Manifestation of Portal Hypertension

2019 ◽  
Vol 37 (3) ◽  
pp. 156-159
Author(s):  
Deepankar Kumar Basak ◽  
Richmond Ronald Gomes ◽  
Md Samsul Arfin
Keyword(s):  
Portal Hypertension ◽  
Short Review ◽  
Injection Sclerotherapy ◽  
Endoscopic Variceal Ligation ◽  
Endoscopic Injection ◽  
Esophageal Variceal ◽  
Esophageal Variceal Bleeding ◽  
Duodenal Varices ◽  
Vein Thrombosis ◽  
Ectopic Varices

We report a case of haematemesis & melaena due to ectopic varices located in the duodenum in a patient with NASH related CLD. Duodenal varices are a rare but potentially serious consequence of portal hypertension in the event of a bleeding. The etiology of duodenal varices can be classified into hepatic (e.g. cirrhosis) or extra hepatic (e.g. portal, splenic or superior mesenteric vein thrombosis). Endoscopic injection sclerotherapy (EIS) and endoscopic variceal ligation (EVL) are widely accepted as primary therapies for esophageal variceal bleeding whereas bleeding gastric fundal varices are usually treated with cyanoacrylate injection or shunt procedures. However there is no widely accepted treatment modality for duodenal varices. In the case presented, we used injection sclerotherapy with ethanolamine oleate, to obliterate varices and control bleeding. A short review on the etiology pathogenesis and management of ectopic varices is presented. J Bangladesh Coll Phys Surg 2019; 37(3): 156-159

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