Abstract
BackgroundDuodenal varices are a low-frequency cause of gastrointestinal bleeding; however, greater than 40 % mortality has been reported after the initial bleeding episode.Case presentationThis report describes a 72-year-old woman with bleeding duodenal varices treated by surgery after failure of balloon-occluded retrograde transvenous obliteration (B-RTO). The patient presented with profuse melena. Emergent upper endoscopy was immediately performed, and bleeding duodenal varices in the second portion of the duodenum were seen. Endoscopic band ligation was attempted first followed by B-RTO; however, the combined procedures failed. Laparotomy under general anesthesia was then performed, and the venous collaterals were cannulated using an 18-gauge needle. Following intraoperative angiography, the venous collateral was ligated on the peripheral side of the needle entry point, and ethanolamine oleate was injected into the afferent collateral vessel. Endoscopic examination on postoperative day 4 showed embolization of the duodenal varices. The patient was discharged on postoperative day 11.ConclusionsThis technique is simple and effective, and we believe it is a potential alternative surgical treatment for duodenal varices with portal hypertension.
Highlights
Duodenal varices are a low-frequency cause of gastrointestinal bleeding; greater than 40 % mortality has been reported after the initial bleeding episode [1, 2]
We present a novel surgical technique for bleeding duodenal varices after failure of balloon-occluded retrograde transvenous obliteration (B-RTO)
Case presentation A 72-year-old woman with liver cirrhosis confirmed based on hepatitis C virus serology presented with profuse melena
Summary
We believe that direct injection of ethanolamine oleate into the afferent collateral vessel under laparotomy could be an alternative surgical hematemesis for rupture of duodenal varicose vein when EVL and B-RTO were failed. Competing interests The authors declare that they have no competing interests. Authors’ contributions GA drafted the manuscript and performed the surgery. AM, KK, and SS revised the manuscript. All authors read and approved the final manuscript. Ethics approval and consent to participate All procedures were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The patient gave informed consent for the procedures. Consent for publication Informed consent was obtained from the patient to publish the details of her case
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
