Varicose veins of the jejunum as a rare source of recurrent bleeding

Abstract

Ectopic varices are any pathologically dilated collaterals in diff erent areas of the gastrointestinal tract, developing as a result of portal hypertension. When localized in the digestive system, varicose veins can be the cause of approximately 5% of cases of bleeding, with a high (up to 40%) fatality rate due to the diffi culty in diagnosing and treating them. The aim of this study is to present a rare clinical observation of recurrent gastrointestinal bleeding from varicose veins of the small intestine. Materials and methods: this article presents a clinical case of recurrent bleeding from ectopic varicose veins of the small intestine in a 65-year-old female patient. The patient was admitted to our hospital with complaints of tarry stools and weakness. She had undergone esophagogastroduodenoscopy (EGD) and colonoscopy (CS) at her place of residence, but no pathology was detected. She was referred to the surgical department of the State Budgetary Healthcare Institution “City Clinical Hospital No. 2” to determine the treatment strategy. In the conditions of the City Clinical Hospital No. 2 in Krasnodar, comprehensive endoscopic diagnostics of the digestive system were performed on the patient, including EGD, CS, video capsule endoscopy (VCE), and balloon-assisted enteroscopy (BAE). Results: erosions of the prepyloric part of the stomach were detected during EGD. Data indicating bleeding from the upper parts of the digestive system were found during colonoscopy. After appropriate preparation, video capsule endoscopy (VCE) was performed on the patient, which revealed signs of ongoing bleeding. Balloonassisted enteroscopy (BAE) was performed on the patient under endotracheal anesthesia in the operating room. Multiple bluish varicose veins, protruding into the lumen up to a distance of 4–5 mm, were visualized throughout the examined length of the small intestine (80 cm from the Treitz ligament). The patient underwent surgical intervention — resection of the aff ected segment of the small intestine. Conclusions: the presented modern methods of small bowel examination — capsule endoscopy and balloon-assisted enteroscopy — provide the opportunity for highly informative endoscopic examination, which signifi cantly aff ects the timeliness of diagnosis and early detection of small bowel diseases.