The first case of balloon-occluded retrograde transvenous obliteration and partial splenic embolization for gastric varices in situs inversus abdominus

Yusuke Watanabe,Shuji Terai,Nobuo Waguri,Akihiko Osaki

doi:10.1007/s12328-020-01332-z

Yusuke Watanabe, Shuji Terai + Show 2 more

Open Access

https://doi.org/10.1007/s12328-020-01332-z

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Abstract

Situs inversus abdominus is a congenital abnormality characterized by the mirror image positioning of the abdominal organs, making it difficult to diagnosis and treatment of many diseases. Here, we report a rare case of gastric varices in situs inversus abdominus patient. A 55-year-old man was diagnosed with F2-shaped gastric varices associated with alcoholic cirrhosis. Abdominal dynamic computed tomography showed situs inversus abdominus, and gastric varices with a gastrorenal shunt. Due to the complex anatomy, emergency interventional radiology during bleeding was extremely difficult. Therefore, after thorough consultation, we decided to treat gastric varices prophylactically by balloon-occluded retrograde transvenous obliteration. After treatment, the patient’s clinical course was generally good, with no adverse events, and the gastric varices disappeared. It is important to assess anatomical positioning using three-dimensional reconstruction computed tomography images before treatment, to adequately prepare, including selecting appropriate devices (i.e., catheters and sheath). Although preventive treatment of gastric varices is controversial, in cases with anatomical complexity, preventive treatment with sufficient preparation would be recommended. To the best of our knowledge, there are no reports of treatment for gastric varices in situs inversus abdominus patient. This case will serve as a reference for successful treatment in future cases.

Highlights

Gastrointestinal varices are often caused by hemodynamic changes that compensate for portal hypertension
A retrospective study of Balloon-occluded retrograde transvenous obliteration (BRTO) showed that the clinical success rate of BRTO—that is, no recurrence of gastric varices (GVs) with no rebleeding—was 97.3%, confirming the efficacy of BRTO [7]
Exacerbation of esophageal varices (EVs) has been observed in 33.3% of patients treated with BRTO without partial splenic embolization (PSE) [7]

Summary

Introduction

Gastrointestinal varices are often caused by hemodynamic changes that compensate for portal hypertension. Balloon-occluded retrograde transvenous obliteration (BRTO) is a widespread and well-reported treatment, whether preventive or emergency, for solitary varices derived from gastrorenal shunts (GRS) [5]. We report an SIA case of BRTO and partial splenic embolization (PSE) for GVs. A 55-year-old man with alcoholic cirrhosis presented with abdominal pain and underwent esophagogastroduodenoscopy showing F2-shaped GVs (Lg-cf, RC0) and F1-shaped EVs (Li, RC0) (Fig. 1a, b). Abdominal dynamic computed tomography (CT) showed SIA, polysplenia, EVs, GRS, and GVs (Fig. 1c–f). GVs gastric varices, IVC inferior vena cava, PV portal vein, RV renal vein, SMV superior mesenteric vein, SPV splenic portal vein the prophylactic treatment. The portal phase of splenic arteriography showed a GRS, afferent veins (posterior gastric and left gastric veins), and an efferent vein (right renal vein) as shown in the 3D CT (Fig. 3a). There was no portal vein thrombosis, decreased hepatic functional reserve, exacerbation of EVs, or ectopic varices

Discussion

Findings

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