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
ARTICLE HIGHLIGHTS
Case characteristics
A 57-year-old Asian woman with autoimmune portal hypertension due to polymyositis was admitted to our hospital with a 2-d history of hematochezia. She had a history of esophageal variceal rupture, which had been treated by endoscopy 3 years before.
Clinical diagnosis
On the 3rd day after admission, she had massive hematochezia. The authors performed a second multi-detector row CT (MDCT) and angiography and diagnosed as massive ileal varix bleeding because there was a massive coagula at the distal ileal lumen of the ileal varix.
Differential diagnosis
There was no differential diagnosis because upper and lower endoscopic examinations could not detect the responsible lesion.
Laboratory diagnosis
Laboratory diagnosis was a severe anemia with hemoglobin 7.3 g/dL and hematocrit 23.4% because other data showed no apparent disorder.
Imaging diagnosis
Imaging diagnosis by MDCT and its angiography was massive ileal varix bleeding because there was a massive coagula at the distal ileal lumen of the ileal varix.
Pathological diagnosis
Pathological diagnosis was the leal varix.
Treatment
The authors performed emergent segmental ileal resection, which included the ileal varix, via a small laparotomy. The varix was located at the 20-cm proximal portion of the ileocecal valve.
Related reports
Jejunal varices as a cause of massive gastrointestinal bleeding. Am J Gastroenterol 1992; 87: 514-517.
Term explanation
The authors used common terms, which were used in previous reports.
Experiences and lessons
Ectopic gastrointestinal variceal bleeding might be considered as a differential diagnosis if upper or lower endoscopy could not detect bleeding point. From the review results of previous reports including our case, 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.
