超音波内視鏡で確認し，硬化療法にて止血しえた回腸導管静脈瘤の1例

Abstract

A 57-year-old man, with bladder cancer had undergone cystectomy with construction of a ileal conduit ten years previously. Following blood transfusion, he developed serum hepatitis (type C) . Since two years the patient began having episodes of massive bleeding from the stoma frequently. MR and mesenteric angiogram showed winding of the vessels around ileal conduit, these findings suggested stomal varices. Endoscopic ultrasonography (EUS : 7.5MHz linear) revealed winding hypoechoic area at the level of mucosal-submucasal layer. Sclerosing therapy (1% Aethoxysklerol) and ligation of some superficial bleeding veins were conducted several times, bleeding ceased for one or two weeks, however strong bleeding continued to occur. The patient was admitted on emergency because of massive bleeding. The varices was confirmed by EUS. EUS guided puncture of the varices using a 21G PEIT needle and injection sclerotherapy was applied with 50% cyanoacryl (add lipiodol) . After the treatment the patient has no bleeding episode for six months. Stomal variceal bleeding from ileal conduit in a patients with portal hypertension is not frequent, but difficult to manage. Diagnostic EUS is available procedure for stomal varices, EUS guided sclerosing therapy with cyanoacrylate injection is usefull method of preventing recurrent bleeding.