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Endoscopic injection sclerotherapy for pediatric bleeding esophageal varices complicated by gastric vein, main portal vein, splenic mesenteric junction, and splenic vein occlusion: a case report.
BMC Gastroenterol. 2019 Feb 28; 19(1):37.BG

Abstract

BACKGROUND

Endoscopic injection sclerotherapy (EIS) is a life-saving procedure for pediatric patients with bleeding gastric varices (GV) associated with advanced liver cirrhosis and severe portal hypertension. Because of the lack of an endoscopic banding ligation device for pediatric patients, EIS is usually performed for bleeding esophageal varices (EV) in infants with congenital biliary atresia.

CASE PRESENTATION

We present a case of a 15-month-old female infant with type I biliary atresia with jaundice (total serum bilirubin, 22.2 mg/dL), hypoalbuminemia (serum albumin level, 2.58 g/dL), coagulopathy (prothrombin time > 20 s compared with that of a normal control), ascites, splenomegaly, portal hypertension (portal vein velocity, 3.9-5.6 cm/sec of hepatopetal flow), and repeated bleeding of the varices after receiving three doses of intravascularly administered Histoacryl 1 ampoule mixed with Lipiodol UF 8 mL in the EV. Prominent GV and EV were occluded by EIS. The sclerosing agent was also present in the main portal vein, splenic mesenteric junction, and splenic vein, causing an engorged inferior mesenteric vein. The patient underwent total hepatectomy and living donor liver transplantation (LDLT) by left lateral segment graft (segments 2, 3, and 4 of the middle hepatic vein trunk) and left portal vein graft to the recipient inferior mesenteric vein anastomosis. Portal vein stent placement via segment 4 of the portal vein stump was performed from the inferior mesenteric vein to the umbilical portion of the left portal vein. The patient is still alive and doing well after the LDLT.

CONCLUSIONS

EIS is a life-saving procedure in cases involving bleeding EV complicated by gastric, main portal vein, splenic mesenteric junction, and splenic vein occlusions; hence, it should be kept in mind as a treatment for EV complications in pediatric patients.

Authors+Show Affiliations

Chang Gung University, College of Medicine, Taoyuan, Taiwan. c471026@ms6.hinet.net. Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. c471026@ms6.hinet.net. Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. c471026@ms6.hinet.net.Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. ccyong3980@gmail.com. Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. ccyong3980@gmail.com.Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.Liver Transplant Program, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Department of General Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

30819091

Citation

Chiu, King-Wah, et al. "Endoscopic Injection Sclerotherapy for Pediatric Bleeding Esophageal Varices Complicated By Gastric Vein, Main Portal Vein, Splenic Mesenteric Junction, and Splenic Vein Occlusion: a Case Report." BMC Gastroenterology, vol. 19, no. 1, 2019, p. 37.
Chiu KW, Lin TL, Yong CC, et al. Endoscopic injection sclerotherapy for pediatric bleeding esophageal varices complicated by gastric vein, main portal vein, splenic mesenteric junction, and splenic vein occlusion: a case report. BMC Gastroenterol. 2019;19(1):37.
Chiu, K. W., Lin, T. L., Yong, C. C., Lin, C. C., Cheng, Y. F., & Chen, C. L. (2019). Endoscopic injection sclerotherapy for pediatric bleeding esophageal varices complicated by gastric vein, main portal vein, splenic mesenteric junction, and splenic vein occlusion: a case report. BMC Gastroenterology, 19(1), 37. https://doi.org/10.1186/s12876-019-0955-7
Chiu KW, et al. Endoscopic Injection Sclerotherapy for Pediatric Bleeding Esophageal Varices Complicated By Gastric Vein, Main Portal Vein, Splenic Mesenteric Junction, and Splenic Vein Occlusion: a Case Report. BMC Gastroenterol. 2019 Feb 28;19(1):37. PubMed PMID: 30819091.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endoscopic injection sclerotherapy for pediatric bleeding esophageal varices complicated by gastric vein, main portal vein, splenic mesenteric junction, and splenic vein occlusion: a case report. AU - Chiu,King-Wah, AU - Lin,Ting-Lung, AU - Yong,Chee-Chien, AU - Lin,Chih-Che, AU - Cheng,Yu-Fan, AU - Chen,Chao-Long, Y1 - 2019/02/28/ PY - 2019/01/16/received PY - 2019/02/20/accepted PY - 2019/3/2/entrez PY - 2019/3/2/pubmed PY - 2019/3/6/medline KW - Biliary atresia KW - Complication KW - Endoscopic injection sclerotherapy KW - Esophageal varices KW - Living donor liver transplantation SP - 37 EP - 37 JF - BMC gastroenterology JO - BMC Gastroenterol VL - 19 IS - 1 N2 - BACKGROUND: Endoscopic injection sclerotherapy (EIS) is a life-saving procedure for pediatric patients with bleeding gastric varices (GV) associated with advanced liver cirrhosis and severe portal hypertension. Because of the lack of an endoscopic banding ligation device for pediatric patients, EIS is usually performed for bleeding esophageal varices (EV) in infants with congenital biliary atresia. CASE PRESENTATION: We present a case of a 15-month-old female infant with type I biliary atresia with jaundice (total serum bilirubin, 22.2 mg/dL), hypoalbuminemia (serum albumin level, 2.58 g/dL), coagulopathy (prothrombin time > 20 s compared with that of a normal control), ascites, splenomegaly, portal hypertension (portal vein velocity, 3.9-5.6 cm/sec of hepatopetal flow), and repeated bleeding of the varices after receiving three doses of intravascularly administered Histoacryl 1 ampoule mixed with Lipiodol UF 8 mL in the EV. Prominent GV and EV were occluded by EIS. The sclerosing agent was also present in the main portal vein, splenic mesenteric junction, and splenic vein, causing an engorged inferior mesenteric vein. The patient underwent total hepatectomy and living donor liver transplantation (LDLT) by left lateral segment graft (segments 2, 3, and 4 of the middle hepatic vein trunk) and left portal vein graft to the recipient inferior mesenteric vein anastomosis. Portal vein stent placement via segment 4 of the portal vein stump was performed from the inferior mesenteric vein to the umbilical portion of the left portal vein. The patient is still alive and doing well after the LDLT. CONCLUSIONS: EIS is a life-saving procedure in cases involving bleeding EV complicated by gastric, main portal vein, splenic mesenteric junction, and splenic vein occlusions; hence, it should be kept in mind as a treatment for EV complications in pediatric patients. SN - 1471-230X UR - https://www.unboundmedicine.com/medline/citation/30819091/Endoscopic_injection_sclerotherapy_for_pediatric_bleeding_esophageal_varices_complicated_by_gastric_vein_main_portal_vein_splenic_mesenteric_junction_and_splenic_vein_occlusion:_a_case_report_ L2 - https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-019-0955-7 DB - PRIME DP - Unbound Medicine ER -