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Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices.
World J Gastroenterol. 2009 Aug 14; 15(30):3823-6.WJ

Abstract

A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up.

Authors+Show Affiliations

Department of Gastroenterology and Hepatology, National University Hospital, 5 Lower Kent Ridge Road, 119074, Singapore 119074, Singapore. lee_guan_lim@nuhs.edu.sgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

19673028

Citation

Lim, Lee-Guan, et al. "Percutaneous Paraumbilical Embolization as an Unconventional and Successful Treatment for Bleeding Jejunal Varices." World Journal of Gastroenterology, vol. 15, no. 30, 2009, pp. 3823-6.
Lim LG, Lee YM, Tan L, et al. Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. World J Gastroenterol. 2009;15(30):3823-6.
Lim, L. G., Lee, Y. M., Tan, L., Chang, S., & Lim, S. G. (2009). Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. World Journal of Gastroenterology, 15(30), 3823-6.
Lim LG, et al. Percutaneous Paraumbilical Embolization as an Unconventional and Successful Treatment for Bleeding Jejunal Varices. World J Gastroenterol. 2009 Aug 14;15(30):3823-6. PubMed PMID: 19673028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous paraumbilical embolization as an unconventional and successful treatment for bleeding jejunal varices. AU - Lim,Lee-Guan, AU - Lee,Yin-Mei, AU - Tan,Lenny, AU - Chang,Stephen, AU - Lim,Seng-Gee, PY - 2009/8/13/entrez PY - 2009/8/13/pubmed PY - 2009/10/23/medline SP - 3823 EP - 6 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 15 IS - 30 N2 - A 48-year-old Indian male with alcoholic liver cirrhosis was admitted after being found unresponsive. He was hypotensive and had hematochezia. Esophagogastroduodenoscopy (EGD) showed small esophageal varices and a clean-based duodenal ulcer. He continued to have hematochezia and anemia despite blood transfusions. Colonoscopy was normal. Repeat EGD did not reveal any source of recent bleed. Twelve days after admission, his hematochezia ceased. He refused further investigation and was discharged two days later. He presented one week after discharge with hematochezia. EGD showed non-bleeding Grade 1 esophageal varices and a clean-based duodenal ulcer. Colonoscopy was normal. Abdominal computed tomography (CT) showed liver cirrhosis with mild ascites, paraumbilical varices, and splenomegaly. He had multiple episodes of hematochezia, requiring repeated blood transfusions. Capsule endoscopy identified the bleeding site in the jejunum. Concurrently, CT angiography showed paraumbilical varices inseparable from a loop of small bowel, which had herniated through an umbilical hernia. The lumen of this loop of small bowel opacified in the delayed phase, which suggested variceal bleeding into the small bowel. Portal vein thrombosis was present. As he had severe coagulopathy and extensive paraumbilical varices, surgery was of high risk. He was not suitable for transjugular intrahepatic porto-systemic shunt as he had portal vein thrombosis. Percutaneous paraumbilical embolization via caput medusa was performed on day 9 of hospitalization. Following the embolization, the hematochezia stopped. However, he defaulted subsequent follow-up. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/19673028/Percutaneous_paraumbilical_embolization_as_an_unconventional_and_successful_treatment_for_bleeding_jejunal_varices_ L2 - http://www.wjgnet.com/1007-9327/full/v15/i30/3823.htm DB - PRIME DP - Unbound Medicine ER -