1/33. Combination of transileocolic vein obliteration and balloon-occluded retrograde transvenous obliteration is effective for ruptured duodenal varices.Duodenal varices are a rare site of hemorrhage in patients with portal hypertension, but their rupture is a serious and often fatal event. We report a 65-year-old woman who presented with hematemesis and melena. She was admitted to our department because of prolonged shock, despite having received transfusion of a large volume of blood. Upper gastrointestinal endoscopy revealed nodular varices with active bleeding in the second portion of the duodenum. Endoscopic injection sclerotherapy (EIS) was performed using a tissue adhesive agent, alpha-cyanoacrylate monomer, with only temporary benefit. However, anemia continued to progress after the procedure. Therefore, we combined transileocolic vein obliteration (TIO) with balloon-occluded retrograde transvenous obliteration (B-RIO), using 5% ethanolamine oleate with iopamidol to obliterate the varices. Complete hemostasis was achieved without complications. Neither recurrence of varices nor further bleeding has occurred for over 3 years. We conclude that combined TIO and B-RTO, which can obstruct both the feeding and the draining vessels of duodenal varices to retain the sclerosing agent completely in the varices, is a safe and effective hemostatic measure for ruptured duodenal varices, when EIS has failed to accomplish complete hemostasis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/33. hemoperitoneum following rupture of ectopic varix along splenorenal ligament in extrahepatic portal vein obstruction.A 29-year-old man with extrahepatic portal vein obstruction who underwent variceal eradication by sclerotherapy six years ago, was admitted with hypotension and abdominal pain. Abdominal paracentesis yielded frank blood. laparotomy showed bleeding from a large ectopic vessel along the splenorenal ligament. The vessel was ligated and the patient recovered.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/33. Massive gastrointestinal bleeding from jejunal varices.We report a patient with massive gastrointestinal bleeding from jejunal varices, confirmed by emergency laparotomy. A 54-year-old woman was admitted to Chonnam National University Hospital with a 5-day history of melena with hematochezia. Fifteen years previously, she had undergone cholecystectomy for gallstone. Seven years previously, she had undergone an operation because of possible common bile duct stone. The details of this operation were not known. Upper gastrointestinal endoscopy revealed no varices in the esophagus, stomach, and proximal duodenum. colonoscopy demonstrated black-colored blood clots throughout the colon. A technetium-99m-labeled red blood cell (RBC) scan showed active proximal small bowel bleeding. Abdominal aortic angiography revealed mesenteric varices in the upper abdomen, but no active bleeding source was recognized. Because of the patient's continued massive gastrointestinal bleeding despite medical therapy, emergency laparotomy was performed. We found evidence of micronodular cirrhosis of the liver and an apparent Roux-en-Y anastomosis. There were numerous collateral variceal vessels in the jejunal limb with the liver and abdominal wall. Segmental resection of the involved jejunum and end-to-end anastomosis were perdilated formed. Histologic examination revealed submucosal veins with mucosal erosion.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/33. Coronary artery ectasia, aneurysm of the basilar artery and varicose veins: common presentation or generalized defect of the vessel wall? A case report.A young man who suffered from an acute myocardial infarction is presented. He presented coronary artery ectasia along with coronary artery disease. Further evaluation revealed the presence of both a saccular aneurysm of the basilar artery as well as varicose veins of the lower limbs. A common pathogenic mechanism is discussed since all these findings are characterized by similar histologic substrate with the most profound defect being destruction of the myoelastic elements of the media.- - - - - - - - - - ranking = 4keywords = vessel (Clic here for more details about this article) |
5/33. Severe fatty change of the graft liver caused by a portosystemic shunt of mesenteric varices.Portosystemic shunt is a common complication in patients with portal hypertension. Mesenteric varix is one of the collaterals that can cause post-transplant liver dysfunction. In this case report, a 45-year-old woman underwent living relative donor liver transplantation for alcoholic cirrhosis. Although the early postoperative course was uneventful, she was readmitted for treatment of liver hypofunction. Fatty change in the graft liver was confirmed by histopathology of the biopsy specimen. The venous phase of a superior mesenteric angiogram revealed large-caliber mesenteric varices comprising portosystemic venous shunts. Surgery was performed to ligate the shunts. The intraoperative color Doppler ultrasonography showed hepatofugal portal blood flow, which was corrected to hepatopetal blood flow by clamping the shunt vessels. The portal pressure was moderately elevated from 13.6 cm to 21.8 cm H(2)O. Two shunt vessels were ligated and divided. Her liver function returned to nearly normal thereafter. We recommend that descending collaterals be divided during liver transplantation.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/33. Persistent sciatic vessels, varicose veins, and lower limb hypertrophy: an unusual case or discrete clinical syndrome?Persistent sciatic artery is a rare congenital anomaly with a high incidence rate of aneurysmal degeneration and risk of thromboembolization or rupture. Despite a number of recognized associations, the presence of coexistent venous anomalies is extremely rare. We present the case of a 27-year-old woman with atypical left-sided varicose veins and soft tissue hypertrophy. Imaging showed persistence of both sciatic artery and vein. Whether these anomalies are an incidental finding or represent a discrete clinical syndrome remains unclear. We emphasize that unusual distribution varicose veins may be associated with underlying persistent sciatic vessels and recommend formal duplex scan assessment for these anomalies.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
7/33. Extensive varices of ileocecum. Report of a case.A man was admitted to our hospital because of intestinal reddish bleeding. Colonic varices were found at the cecum by colonoscopy. angiography of the superior mesenteric artery showed that blood vessels were scant from the end of the ileum to the ascending colon. An operative view revealed the varices, but there was no trace of the ileocecal vein. This case, presenting a deficit of the ileocecal vein, indicated that the blood flow could not return via the ileocecal vein, and therefore there was an outflow through the varices to the surrounding intestine or abdominal veins. Such a case is probably unrepresented in the literature because it was caused by the total deficiency of the ileocecal vein and it was in the right colon.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/33. Familial and idiopathic colonic varices: an unusual cause of lower gastrointestinal haemorrhage.A patient is described presenting with an acute lower gastrointestinal haemorrhage as a result of extensive colonic varices. Further investigation revealed that there were no oesophageal varices or splenomegaly. Liver biopsy showed grade II fatty change only, with no other specific or significant pathological features. Transhepatic portography showed a raised portal pressure (20 mm/Hg) but the portal system was patent throughout. There was an abnormal leash of vessels in the caecum thought to represent a variceal plexus. This patient was diagnosed as having idiopathic colonic varices. This case is discussed together with nine other reports of idiopathic colonic varices from the published literature. Four of these reports describe idiopathic colonic varices in more than one member of the same family. Possible modes of inheritance, aetiology of variceal change, natural history, and prognosis are discussed.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/33. Painful vascular compression syndrome of the sciatic nerve caused by gluteal varicosities.The authors report three patients with chronic sciatic pain without focal neurologic deficit. Sitting or lying on the affected side provoked pain, and standing and walking relieved it. MRI revealed varicotic gluteal vessels compressing the sciatic nerve. decompression of the nerve resulted in complete and permanent pain relief. Sciatic or buttock pain in patients with varicosities and pain provocation in the sitting or lying position suggests this neurovascular compression syndrome.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/33. Portal hypertensive hemorrhage from a left gastroepiploic vein caput medusa in an adhesed umbilical hernia.Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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