Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2015; 21(3): 1024-1027
Published online Jan 21, 2015. doi: 10.3748/wjg.v21.i3.1024
Protein C deficiency related obscure gastrointestinal bleeding treated by enteroscopy and anticoagulant therapy
Wei-Fan Hsu, Yuk-Ming Tsang, Chung-Jen Teng, Chen-Shuan Chung
Wei-Fan Hsu, Chung-Jen Teng, Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
Yuk-Ming Tsang, Department of Radiology, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
Chen-Shuan Chung, College of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
Chen-Shuan Chung, Taiwan Association for the Study of Small Intestinal Diseases, New Taipei City 22060, Taiwan
Author contributions: Hsu WF and Chung CS designed the research; Chung CS performed the enteroscopy; Tsang YM reviewed the computed tomography and angiography findings; Teng CJ reviewed the disease of protein C deficiency; Hsu WF wrote the paper; and Chung CS approved the final version.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chen-Shuan Chung, MD, MSc, Department of Internal Medicine, Far Eastern Memorial Hospital, 21, Section 2, Nan-Ya South Road, Banciao District, New Taipei City 22060, Taiwan. chungchenshuan_3@yahoo.com.tw
Telephone: +886-2-89667000-1704 Fax: +886-2-77380091
Received: May 3, 2014
Peer-review started: May 4, 2014
First decision: June 27, 2014
Revised: July 6, 2014
Accepted: July 30, 2014
Article in press: July 30, 2014
Published online: January 21, 2015
Processing time: 262 Days and 13.9 Hours
Abstract

Obscure gastrointestinal bleeding is an uncommonly encountered and difficult-to-treat clinical problem in gastroenterology, but advancements in endoscopic and radiologic imaging modalities allow for greater accuracy in diagnosing obscure gastrointestinal bleeding. Ectopic varices account for less than 5% of all variceal bleeding cases, and jejunal variceal bleeding due to extrahepatic portal hypertension is rare. We present a 47-year-old man suffering from obscure gastrointestinal bleeding. Computed tomography of the abdomen revealed multiple vascular tufts around the proximal jejunum but no evidence of cirrhosis, and a visible hypodense filling defect suggestive of thrombus was visible in the superior mesenteric vein. Enteroscopy revealed several serpiginous varices in the proximal jejunum. Serologic data disclosed protein C deficiency (33.6%). The patient was successfully treated by therapeutic balloon-assisted enteroscopy and long-term anticoagulant therapy, which is normally contraindicated in patients with gastrointestinal bleeding. Diagnostic modalities for obscure gastrointestinal bleeding, such as capsule endoscopy, computed tomography enterography, magnetic resonance enterography, and enteroscopy, were also reviewed in this article.

Keywords: Angiography; Computed tomography; Enteroscopy; Obscure gastrointestinal bleeding; Protein C deficiency; Superior mesenteric venous thrombosis

Core tip: This article presents a rare case of obscure gastrointestinal bleeding-jejunal variceal bleeding and superior mesenteric venous thrombosis. The variceal bleeding and superior mesenteric venous thrombosis were secondary to protein C deficiency. It is worth mentioning that the bleeding was controlled under anticoagulant therapy after therapeutic enteroscopy.