A case of percutaneous transhepatic portal vein stent placement and endoscopic injection sclerotherapy for duodenal variceal rupture occurring during chemotherapy for unresectable perihilar cholangiocarcinoma.

Abstract

Duodenal varices are ectopic varices that are rare but can involve any site along the digestive tract outside the gastroesophageal region. Ectopic variceal bleeding is generally massive and life threatening; the mortality rate is approximately 40%. Up to 17% of ectopic varices occur in the duodenum. However, duodenal varices pose a significant therapeutic challenge due to the lack of standard treatment guidelines. We report a case of duodenal variceal bleeding secondary to portal vein stenosis in a 77-year-old woman receiving chemotherapy for unresectable perihilar cholangiocarcinoma. The patient presented with melena, nausea, vomiting and unstable vital signs suggestive of hemorrhagic shock. Emergency esophagogastroduodenoscopy revealed large nodular varices with a ruptured erosion on top in the superior duodenal angle, and variceal bleeding had stopped by the time of the procedure. Subsequent computed tomography showed the development of portosystemic collaterals; therefore, we performed percutaneous portal vein stent placement to reduce portal vein pressure. Since persistent bleeding was suspected, we also performed endoscopic injection sclerotherapy and achieved successful hemostasis with an improvement in liver function. This case revealed that a combination of portal vein stent placement and endoscopic injection sclerotherapy might be an effective therapy for duodenal variceal bleeding caused by portal vein stenosis.

• Authors: Koshiro Fukuda, Takashi Sasaki, Toshiaki Hirasawa, Kiyoshi Matsueda, Eisuke Nakao, Takafumi Mie, Takaaki Furukawa, Yuto Yamada, Tsuyoshi Takeda, Akiyoshi Kasuga, Masato Matsuyama, Masato Ozaka, Naoki Sasahira
• Journal: Clinical journal of gastroenterology (Clin J Gastroenterol) Vol. 13 Issue 6 Pg. 1150-1156 (Dec 2020) ISSN: 1865-7265 [Electronic] Japan
• PMID: 32897499 (Publication Type: Case Reports, Journal Article)

Topics

• Aged
• Bile Duct Neoplasms (complications, therapy)
• Esophageal and Gastric Varices
• Female
• Gastrointestinal Hemorrhage (etiology, therapy)
• Humans
• Klatskin Tumor
• Portal Vein
• Sclerotherapy (adverse effects)
• Stents