Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2017; 9(12): 288-292
Published online Dec 27, 2017. doi: 10.4240/wjgs.v9.i12.288
Ectopic gastrointestinal variceal bleeding with portal hypertension
Keita Minowa, Shuhei Komatsu, Kenichiro Takashina, Sachie Tanaka, Tatsuya Kumano, Kenichiro Imura, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi, Yasuo Ueshima, Tecchuu Lee, Eito Ikeda, Eigo Otsuji, Yasuhiro Shioaki
Keita Minowa, Shuhei Komatsu, Kenichiro Takashina, Sachie Tanaka, Tatsuya Kumano, Kenichiro Imura, Katsumi Shimomura, Jun Ikeda, Fumihiro Taniguchi, Yasuo Ueshima, Tecchuu Lee, Eito Ikeda, Yasuhiro Shioaki, Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
Keita Minowa, Kenichiro Takashina, Emergency and Critical Care Center, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
Shuhei Komatsu, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
Author contributions: Minowa K, Komatsu S, Takashina K, Tanaka S, Kumano T, Imura K, Shimomura K, Ikeda J, Taniguchi F, Ueshima Y, Lee T, Ikeda E, Otsuji E and Shioaki Y performed research and analyzed the data; Minowa K and Komatsu S wrote the paper and contributed equally to this work.
Informed consent statement: Subject provided signed informed consent. Patients were treated according to the provisions of the Helsinki criteria to conduct research involving human subjects.
Conflict-of-interest statement: We have no conflict of interest to disclose.
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: Shuhei Komatsu, MD, PhD, Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto 605-0981, Japan. skomatsu@koto.kpu-m.ac.jp
Telephone: +81-75-5611121 Fax: +81-75-5616308
Received: August 26, 2017
Peer-review started: August 27, 2017
First decision: September 25, 2017
Revised: October 20, 2017
Accepted: November 11, 2017
Article in press: November 11, 2017
Published online: December 27, 2017
Abstract

Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we report a case of ectopic ileal variceal bleeding in a 57-year-old woman, which was successfully diagnosed by multi-detector row CT (MDCT) and angiography and treated by segmental ileum resection. To date, there have been no consensus for the treatment of ectopic ileal variceal bleeding. This review was designed to clarify the clinical characteristics of patients with ectopic ileal variceal and discuss possible treatment strategies. From the PubMed database and our own database, we reviewed 21 consecutive cases of ileal variceal bleeding diagnosed from 1982 to 2017. MDCT and angiography is useful for the rapid examination and surgical resection of an affected lesion and is a safe and effective treatment strategy to avoid further bleeding.

Keywords: Ectopic gastrointestinal bleeding, Ileal varix, Portal hypertension

Core tip: Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. If no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. We report here a 57-year-old female case of ectopic ileal variceal bleeding, which were diagnosed by multi-detector row CT (MDCT) and its angiography and treated by segmental ileum resection. From the review results of previous reports, MDCT and its angiography is a rapid and useful examination. Moreover, surgical resection of responsible lesion is safe and effective treatment strategy to avoid further bleeding.