Ectopic gastrointestinal variceal bleeding with portal hypertension
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摘要
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.
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.
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.
引文
1 Lebrec D,Benhamou JP.Ectopic varices in portal hypertension.Clin Gastroenterol 1985;14:105-121[PMID:3872747]
2 Norton ID,Andrews JC,Kamath PS.Management of ectopic varices.Hepatology 1998;28:1154-1158[PMID:9755256 DOI:10.1002/hep.510280434]
3 De Palma GD,Rega M,Masone S,Persico F,Siciliano S,Patrone F,Matantuono L,Persico G.Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension:a capsule endoscopy study.Gastrointest Endosc 2005;62:529-534[PMID:16185966 DOI:10 .1016/S0016-5107(05)01588-9]
4 Yuki N,Kubo M,Noro Y,Kasahara A,Hayashi N,Fusamoto H,Ito T,Kamada T.Jejunal varices as a cause of massive gastrointestinal bleeding.Am J Gastroenterol 1992;87:514-517[PMID:1553940]
5 Joo YE,Kim HS,Choi SK,Rew JS,Kim HR,Kim SJ.Massive gastrointestinal bleeding from jejunal varices.J Gastroenterol 2000;35:775-778[PMID:11063222 DOI:10.1007/s005350070037]
6 Kotfila R,Trudeau W.Extraesophageal varices.Dig Dis 1998;16:232-241[PMID:9732183 DOI:10.1159/000016871]
7 Akhter NM,Haskal ZJ.Diagnosis and management of ectopic varices.Ganstrointestinal Intervention 2012;1:3-10[DOI:10.1016/j.gii.2012.08.001]
8 Castagna E,Cardellicchio A,PulitanòR,Manca A,Fenoglio L.Bleeding ileal varices:a rare cause of chronic anemia in liver cirrhosis.Intern Emerg Med 2011;6:271-273[PMID:20931298 DOI:10.1007/s11739-010-0466-6]
9 López-Benítez R,Seidensticker P,Richter GM,Stampfl U,Hallscheidt P.[Case report:massive lower intestinal bleeding from ileal varices:treatment with transjugular intrahepatic portosystemic shunt(TIPSS)].Radiologe 2007;47:407-410[PMID:16249924 DOI:10 .1007/s00117-005-1279-x]
10 Vamadevan S,Haltmeier T,Groebli Y.Portosystemic shunt via the superior mesenteric and right ovarian vein leading to small intestine bleeding in alcoholic liver cirrhosis.BMJ Case Rep 2013;2013:pii:bcr2013008959[PMID:23513021 DOI:10.1136/bcr-2013-008959]
11 Sato T,Yamazaki K,Toyota J,Karino Y,Ohmura T,Akaike J.Ileal Varices Treated with Balloon-Occluded Retrograde Transvenous Obliteration.Gastroenterology Res 2009;2:122-125[PMID:27956966 DOI:10.4021/gr2009.04.1286]
12 Konishi H,Kikuchi S,Miyashita A,Ichikawa D,Fujiwara H,Kubota T,Ochiai T,Kokuba Y,Yasukawa S,Yanagisawa A,Otsuji E.Minimally invasive surgery for obscure idiopathic ileal varices diagnosed by capsule endoscopy and double balloon endoscopy:report of a case.Surg Today 2010;40:1088-1092[PMID:21046511DOI:10.1007/s00595-009-4180-9]
13 Vidal V,Joly L,Perreault P,Bouchard L,Lafortune M,PomierLayrargues G.Usefulness of transjugular intrahepatic portosystemic shunt in the management of bleeding ectopic varices in cirrhotic patients.Cardiovasc Intervent Radiol 2006;29:216-219[PMID:16284702 DOI:10.1007/s00270-004-0346-4]
14 Vangeli M,Patch D,Terreni N,Tibballs J,Watkinson A,Davies N,Burroughs AK.Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt(TIPS)and embolisation.J Hepatol2004;41:560-566[PMID:15464235 DOI:10.1016/j.jhep.2004.06.024]
15 Hashimoto N,Akahoshi T,Yoshida D,Kinjo N,Konishi K,Uehara H,Nagao Y,Kawanaka H,Tomikawa M,Maehara Y.The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding.Surgery 2010;148:145-150[PMID:20004438 DOI:10.1016/j.surg.2009.10.052]
16 Saad WE,Wagner CC,Lippert A,Al-Osaimi A,Davies MG,Matsumoto AH,Angle JF,Caldwell S.Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration(BRTO).Am J Gastroenterol 2013;108:1612-1619[PMID:23939627DOI:10.1038/ajg.2013.232]
2 Norton ID,Andrews JC,Kamath PS.Management of ectopic varices.Hepatology 1998;28:1154-1158[PMID:9755256 DOI:10.1002/hep.510280434]
3 De Palma GD,Rega M,Masone S,Persico F,Siciliano S,Patrone F,Matantuono L,Persico G.Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension:a capsule endoscopy study.Gastrointest Endosc 2005;62:529-534[PMID:16185966 DOI:10 .1016/S0016-5107(05)01588-9]
4 Yuki N,Kubo M,Noro Y,Kasahara A,Hayashi N,Fusamoto H,Ito T,Kamada T.Jejunal varices as a cause of massive gastrointestinal bleeding.Am J Gastroenterol 1992;87:514-517[PMID:1553940]
5 Joo YE,Kim HS,Choi SK,Rew JS,Kim HR,Kim SJ.Massive gastrointestinal bleeding from jejunal varices.J Gastroenterol 2000;35:775-778[PMID:11063222 DOI:10.1007/s005350070037]
6 Kotfila R,Trudeau W.Extraesophageal varices.Dig Dis 1998;16:232-241[PMID:9732183 DOI:10.1159/000016871]
7 Akhter NM,Haskal ZJ.Diagnosis and management of ectopic varices.Ganstrointestinal Intervention 2012;1:3-10[DOI:10.1016/j.gii.2012.08.001]
8 Castagna E,Cardellicchio A,PulitanòR,Manca A,Fenoglio L.Bleeding ileal varices:a rare cause of chronic anemia in liver cirrhosis.Intern Emerg Med 2011;6:271-273[PMID:20931298 DOI:10.1007/s11739-010-0466-6]
9 López-Benítez R,Seidensticker P,Richter GM,Stampfl U,Hallscheidt P.[Case report:massive lower intestinal bleeding from ileal varices:treatment with transjugular intrahepatic portosystemic shunt(TIPSS)].Radiologe 2007;47:407-410[PMID:16249924 DOI:10 .1007/s00117-005-1279-x]
10 Vamadevan S,Haltmeier T,Groebli Y.Portosystemic shunt via the superior mesenteric and right ovarian vein leading to small intestine bleeding in alcoholic liver cirrhosis.BMJ Case Rep 2013;2013:pii:bcr2013008959[PMID:23513021 DOI:10.1136/bcr-2013-008959]
11 Sato T,Yamazaki K,Toyota J,Karino Y,Ohmura T,Akaike J.Ileal Varices Treated with Balloon-Occluded Retrograde Transvenous Obliteration.Gastroenterology Res 2009;2:122-125[PMID:27956966 DOI:10.4021/gr2009.04.1286]
12 Konishi H,Kikuchi S,Miyashita A,Ichikawa D,Fujiwara H,Kubota T,Ochiai T,Kokuba Y,Yasukawa S,Yanagisawa A,Otsuji E.Minimally invasive surgery for obscure idiopathic ileal varices diagnosed by capsule endoscopy and double balloon endoscopy:report of a case.Surg Today 2010;40:1088-1092[PMID:21046511DOI:10.1007/s00595-009-4180-9]
13 Vidal V,Joly L,Perreault P,Bouchard L,Lafortune M,PomierLayrargues G.Usefulness of transjugular intrahepatic portosystemic shunt in the management of bleeding ectopic varices in cirrhotic patients.Cardiovasc Intervent Radiol 2006;29:216-219[PMID:16284702 DOI:10.1007/s00270-004-0346-4]
14 Vangeli M,Patch D,Terreni N,Tibballs J,Watkinson A,Davies N,Burroughs AK.Bleeding ectopic varices--treatment with transjugular intrahepatic porto-systemic shunt(TIPS)and embolisation.J Hepatol2004;41:560-566[PMID:15464235 DOI:10.1016/j.jhep.2004.06.024]
15 Hashimoto N,Akahoshi T,Yoshida D,Kinjo N,Konishi K,Uehara H,Nagao Y,Kawanaka H,Tomikawa M,Maehara Y.The efficacy of balloon-occluded retrograde transvenous obliteration on small intestinal variceal bleeding.Surgery 2010;148:145-150[PMID:20004438 DOI:10.1016/j.surg.2009.10.052]
16 Saad WE,Wagner CC,Lippert A,Al-Osaimi A,Davies MG,Matsumoto AH,Angle JF,Caldwell S.Protective value of TIPS against the development of hydrothorax/ascites and upper gastrointestinal bleeding after balloon-occluded retrograde transvenous obliteration(BRTO).Am J Gastroenterol 2013;108:1612-1619[PMID:23939627DOI:10.1038/ajg.2013.232]