Öz
Abstract
Duodenal varices are an uncommon site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report the case of a 27- year- old man with liver cirrhosis who presented with upper gastrointestinal bleeding. Upper gastrointestinal endoscopy revealed nodular varices in the second portion of the duodenum which were considered to be the source of bleeding. We decided to inject N-butyl-2-cyanoacrylate (Histoacryl), an adhesive agent, and achieved successful hemostasis. We conclude that endoscopic injection sclerotherapy (EIS) with Histoacryl is an effective treatment option for ruptured duodenal varices.
Keywords: Duodenal varices, upper gastrointestinal hemorrhage, hemostasis
Özet
Duodenal varisler, portal hipertansiyonu olan hastalarda nadir fakat ciddi ve ölümcül bir kanama nedenidir. Üst gastrointestinal kanama ile gelen karaciğer sirozu olan 27 yaşında bir erkek hastayı sunduk. Üst gastrointestinal sistem endoskopisinde, kanama kaynağının duodenum ikinci kısımdaki nodüler varisden olduğunu gördük. Biz adheziv bir ajan olan N-butyl-2-cyanoacrylate (Histoacryl) enjekte ettik ve başarılı bir hemostaz sağladık. Histoacryl ile endoskopik enjeksiyon skleroterapisinin kanayan duodenal varisler için etkili bir tedavi seçeneği olduğuna inanıyoruz.
Anahtar sözcükler: Duodenal varisler, üst gastrointestinal kanama, hemostaz
Anahtar Kelimeler
Kaynakça
- Akazawa Y, Murata I, Yamao T, Yamakawa M, Kawano Y, Nomura N, Isomoto H, Mizuta Y, Murase K, Kohno S. Successful management of bleeding duodenal varices by endoscopic variceal ligation and balloon-occluded retrograde transvenous obliteration. Gastrointest Endosc 2003; 58: 794-7.
- Ota K, Shirai Z, Masuzaki T, Tanaka K, Higashihara H, Okazaki M, Arakawa M. Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices. J Gastroenterol 1998; 33: 550-5.
- Ota K, Okazaki M, Higashihara H, Kokawa H, Shirai Z, Anan A, Kitamura Y, Shijo H. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices. J Gastroenterol 1999; 34: 694-9.
- Tsurusaki M, Sugimoto K, Matsumoto S, Izaki K, Fukuda T, Akasaka Y, Fujii M, Hirota S, Sugimura K. Bleeding Duodenal Varices Successfully Treated with Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO) Assisted by CT During Arterial Portography. Cardiovasc Intervent Radiol 2006; 29: 1148-51.
- McAlister VC, Al-Saleh NA. Duodenal dearterialization and stapling for severe hemorrhage from duodenal varices with portal vein thrombosis. Am J Surg 2005; 189: 49-52.
- Sonomura T, Horihata K, Yamahara K, Dozaiku T, Toyonaga T, Hiroka T, Sato M. Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration: usefulness of microcatheters. AJR Am J Roentgenol 2003; 181: 725-7.
- Bosch A, Marsano L, Varilek GW. Successful obliteration of duodenal varices after endoscopic ligation. Dig Dis Sci 2003; 48: 1809-12.
- Machida T, Sato K, Kojima A, Takezawa J, Sohara N, Kakizaki S, Takagi H, Mori M. Ruptured duodenal varices after endoscopic ligation of esophageal varices: an autopsy case. Gastrointest Endosc 2006; 63: 352-4.
- D'Imperio N, Piemontese A, Baroncini D, Billi P, Borioni D, Dal Monte PP, Borrello P. Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy 1996; 28: 239-43.
- Zargar SA, Javid G, Khan BA, Yattoo GN, Shah AH, Gulzar GM, Singh J, Rehman BU, Din Z. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002; 36: 666-72.
Öz
Duodenal varisler, portal hipertansiyonu olan hastalarda nadir fakat ciddi ve ölümcül bir kanama nedenidir. Üst gastrointestinal kanama ile gelen karaciğer sirozu olan 27 yaşında bir erkek hastayı sunduk. Üst gastrointestinal sistem endoskopisinde, kanama kaynağının duodenum ikinci kısımdaki nodüler varisden olduğunu gördük. Biz adheziv bir ajan olan N-butyl-2-cyanoacrylate (Histoacryl) enjekte ettik ve başarılı bir hemostaz sağladık. Histoacryl ile endoskopik enjeksiyon skleroterapisinin kanayan duodenal varisler için etkili bir tedavi seçeneği olduğuna inanıyoruz
Anahtar Kelimeler
Kaynakça
- Akazawa Y, Murata I, Yamao T, Yamakawa M, Kawano Y, Nomura N, Isomoto H, Mizuta Y, Murase K, Kohno S. Successful management of bleeding duodenal varices by endoscopic variceal ligation and balloon-occluded retrograde transvenous obliteration. Gastrointest Endosc 2003; 58: 794-7.
- Ota K, Shirai Z, Masuzaki T, Tanaka K, Higashihara H, Okazaki M, Arakawa M. Endoscopic injection sclerotherapy with n-butyl-2-cyanoacrylate for ruptured duodenal varices. J Gastroenterol 1998; 33: 550-5.
- Ota K, Okazaki M, Higashihara H, Kokawa H, Shirai Z, Anan A, Kitamura Y, Shijo H. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices. J Gastroenterol 1999; 34: 694-9.
- Tsurusaki M, Sugimoto K, Matsumoto S, Izaki K, Fukuda T, Akasaka Y, Fujii M, Hirota S, Sugimura K. Bleeding Duodenal Varices Successfully Treated with Balloon-Occluded Retrograde Transvenous Obliteration (B-RTO) Assisted by CT During Arterial Portography. Cardiovasc Intervent Radiol 2006; 29: 1148-51.
- McAlister VC, Al-Saleh NA. Duodenal dearterialization and stapling for severe hemorrhage from duodenal varices with portal vein thrombosis. Am J Surg 2005; 189: 49-52.
- Sonomura T, Horihata K, Yamahara K, Dozaiku T, Toyonaga T, Hiroka T, Sato M. Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration: usefulness of microcatheters. AJR Am J Roentgenol 2003; 181: 725-7.
- Bosch A, Marsano L, Varilek GW. Successful obliteration of duodenal varices after endoscopic ligation. Dig Dis Sci 2003; 48: 1809-12.
- Machida T, Sato K, Kojima A, Takezawa J, Sohara N, Kakizaki S, Takagi H, Mori M. Ruptured duodenal varices after endoscopic ligation of esophageal varices: an autopsy case. Gastrointest Endosc 2006; 63: 352-4.
- D'Imperio N, Piemontese A, Baroncini D, Billi P, Borioni D, Dal Monte PP, Borrello P. Evaluation of undiluted N-butyl-2-cyanoacrylate in the endoscopic treatment of upper gastrointestinal tract varices. Endoscopy 1996; 28: 239-43.
- Zargar SA, Javid G, Khan BA, Yattoo GN, Shah AH, Gulzar GM, Singh J, Rehman BU, Din Z. Endoscopic ligation compared with sclerotherapy for bleeding esophageal varices in children with extrahepatic portal venous obstruction. Hepatology 2002; 36: 666-72.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Bölüm | Olgu Sunumları |
| Yazarlar | |
| Yayımlanma Tarihi | 21 Haziran 2012 |
| Yayımlandığı Sayı | Yıl 2012Cilt: 34 Sayı: 2 |