Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

doi:10.3748/wjg.v18.i22.2877

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Jun 14, 2012 (publication date) through Dec 2, 2024

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Jun 14, 2012; 18(22): 2877-2880
Published online Jun 14, 2012. doi: 10.3748/wjg.v18.i22.2877

Duodenal variceal bleeding after balloon-occluded retrograde transverse obliteration: Treatment with transjugular intrahepatic portosystemic shunt

Min Joung Kim, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Young Hwan Kim

Min Joung Kim, Byoung Kuk Jang, Woo Jin Chung, Jae Seok Hwang, Department of Gastroenterology, Keimyung University School of Medicine, Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea

Young Hwan Kim, Department of Diagnostic Radiology, Keimyung University School of Medicine, Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea

Author contributions: Kim MJ and Jang BK contributed equally to this work; Hwang JS and Chung WJ provided clinical advice; Kim YH performed the procedure; Jang BK, Kim MJ and Kim YH designed the case report; and Kim MJ wrote the paper.

Correspondence to: Byoung Kuk Jang, MD, PhD, Department of Gastroenterology, Keimyung University School of Medicine, Dongsan Medical Center, 194 Dongsan-dong, Jung-gu, Daegu 700-712, South Korea. jangha106@dsmc.or.kr

Telephone: +82-53-2507088 Fax: +82-53-2507088

Received: November 17, 2011
Revised: December 29, 2011
Accepted: January 18, 2012
Published online: June 14, 2012

Abstract

We report a case of duodenal varix bleeding as a long term complication of balloon occluded retrograde transvenous obliteration (BRTO), which was successfully treated with a transjugular intrahepatic portosystemic shunt (TIPS). A 57-year-old man was admitted to the emergency room suffering from melena. He had undergone BRTO to treat gastric varix bleeding 5 mo before admission. Endoscopy and a computed tomography (CT) scan showed complete obliteration of the gastric varix, but the nodular varices in the second portion of the duodenum expanded after BRTO, and spurting blood was seen. TIPS was performed for treatment of duodenal variceal bleeding, because attempts at endoscopic varix ligation were unsuccessful. The postoperative course was uneventful and the patient was discharged without complications. A follow up CT scan obtained 21 mo after TIPS revealed a patent TIPS tract and complete obliteration of duodenal varices, but multinodular hepatocellular carcinoma had developed. He died of hepatic failure 28 mo after TIPS.

Keywords: Duodenal variceal bleeding; Balloon occluded retrograde transvenous obliteration; Transjugular intrahepatic portosystemic shunt