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World J Gastroenterol. Oct 7, 2010; 16(37): 4747-4750
Published online Oct 7, 2010. doi: 10.3748/wjg.v16.i37.4747
Published online Oct 7, 2010. doi: 10.3748/wjg.v16.i37.4747
Gastrointestinal bleeding 30 years after a complicated cholecystectomy
Thorsten Brechmann, Wolff Schmiegel, Markus Reiser, Department of Gastroenterology and Hepatology, Berufsgenossenschaftliche Kliniken Bergmannsheil, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Volkmar Nicolas, Department of Diagnostic and Interventional Radiology, Berufsgenossenschaftliche Kliniken Bergmannsheil, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Author contributions: Reiser M and Brechmann T treated the patient, performed the endoscopic procedures and wrote the manuscript; Nicolas V performed and provided the computed tomography imaging; Schmiegel W advised on the treatment plan and revised the manuscript.
Correspondence to: Thorsten Brechmann, MD, Department of Gastroenterology and Hepatology, Berufsgenossenschaftliche Kliniken Bergmannsheil, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. thorsten.brechmann@rub.de
Telephone: +49-234-3026770 Fax: +49-234-3026707
Received: April 22, 2010
Revised: May 31, 2010
Accepted: June 7, 2010
Published online: October 7, 2010
Revised: May 31, 2010
Accepted: June 7, 2010
Published online: October 7, 2010
Abstract
Gastrointestinal bleeding from small-bowel varices is a rare and difficult to treat complication of portal hypertension. We describe the case of a 79-year-old female patient with recurrent severe hemorrhage from small-bowel varices 30 years after a complicated cholecystectomy. When double balloon enteroscopy was unsuccessful to reach the site of bleeding, a rendezvous approach was favored with intraoperative endoscopy. Active bleeding from varices within a biliodigestive anastomosis was found and controlled by endoscopic injection of cyanoacrylate. Intraoperative endoscopy should be considered in the case of life-threatening gastrointestinal hemorrhage that is not accessible by conventional endoscopy.
Keywords: Upper gastrointestinal bleeding, Intestinal varices, Intraoperative endoscopy, Cyanoacrylate