Xie BS, Zhong JW, Wang AJ, Zhang ZD, Zhu X, Guo GH. Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic porto-systemic shunt plus embolization: A case report. World J Clin Cases 2018; 6(16): 1217-1222 [PMID: 30613686 DOI: 10.12998/wjcc.v6.i16.1217]
Corresponding Author of This Article
Gui-Hai Guo, MA, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Street, Nanchang 330006, Jiangxi Province, China. 2267582610@qq.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
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/
World J Clin Cases. Dec 26, 2018; 6(16): 1217-1222 Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1217
Duodenal variceal bleeding secondary to idiopathic portal hypertension treated with transjugular intra-hepatic porto-systemic shunt plus embolization: A case report
Bu-Shan Xie, Jia-Wei Zhong, An-Jiang Wang, Xuan Zhu, Gui-Hai Guo, Department of Gastroenterology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Zhen-Dong Zhang, Department of Pathology, the First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: All authors contributed to the acquisition of data, writing, and revision of this manuscript; Guo GH designed the report and revised the article; Zhong JW, Wang AJ and Zhu X collected the clinical data; Zhang ZD analyzed the pathologic data; Xie BS analyzed the data and wrote the paper.
Supported byNational Natural Science Foundation of China under Grant No. 81503437.
Informed consent statement: The patient and her family provided informed written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that 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/
Corresponding author to: Gui-Hai Guo, MA, Chief Doctor, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, No.17 Yongwai Street, Nanchang 330006, Jiangxi Province, China. 2267582610@qq.com
Telephone: +86-791-88692540 Fax: +86-791-8623153
Received: October 2, 2018 Peer-review started: October 2, 2018 First decision: October 18, 2018 Revised: November 20, 2018 Accepted: November 23, 2018 Article in press: November 24, 2018 Published online: December 26, 2018 Processing time: 83 Days and 6.1 Hours
Abstract
BACKGROUND
Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension (IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt (TIPS) plus embolization.
CASE SUMMARY
A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leading to duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation.
CONCLUSION
TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
Core tip: Duodenal varices are a lesser-known complication of non-cirrhotic portal hypertension. The authors report a complicated case of duodenal varices secondary to idiopathic portal hypertension in a patient with recurrent anemia for two years, which were undetected by the endoscopist at a local hospital, but observed by repeated endoscopy in the digestive department in our hospital. The duodenal varices were arrested by transjugular intra-hepatic porto-systemic shunt plus embolization. To the best of the authors’ knowledge, this is the first report to explore transjugular intra-hepatic porto-systemic shunt treatment for duodenal varices secondary to idiopathic portal hypertension.
