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A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction
BACKGROUND: The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted st...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Berlin Heidelberg
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952481/ https://www.ncbi.nlm.nih.gov/pubmed/31919714 http://dx.doi.org/10.1186/s40792-020-0775-6 |
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author | Shinno, Naoki Kawabata, Ryohei Furukawa, Haruna Goda, Seiichi Sueda, Toshinori Matsumura, Tae Koga, Chikato Noura, Shingo Shimizu, Junzo Okada, Atsuya Hasegawa, Junichi |
author_facet | Shinno, Naoki Kawabata, Ryohei Furukawa, Haruna Goda, Seiichi Sueda, Toshinori Matsumura, Tae Koga, Chikato Noura, Shingo Shimizu, Junzo Okada, Atsuya Hasegawa, Junichi |
author_sort | Shinno, Naoki |
collection | PubMed |
description | BACKGROUND: The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration. CASE PRESENTATION: A 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days. CONCLUSION: PTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites. |
format | Online Article Text |
id | pubmed-6952481 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
spelling | pubmed-69524812020-01-23 A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction Shinno, Naoki Kawabata, Ryohei Furukawa, Haruna Goda, Seiichi Sueda, Toshinori Matsumura, Tae Koga, Chikato Noura, Shingo Shimizu, Junzo Okada, Atsuya Hasegawa, Junichi Surg Case Rep Case Report BACKGROUND: The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration. CASE PRESENTATION: A 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days. CONCLUSION: PTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites. Springer Berlin Heidelberg 2020-01-09 /pmc/articles/PMC6952481/ /pubmed/31919714 http://dx.doi.org/10.1186/s40792-020-0775-6 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Case Report Shinno, Naoki Kawabata, Ryohei Furukawa, Haruna Goda, Seiichi Sueda, Toshinori Matsumura, Tae Koga, Chikato Noura, Shingo Shimizu, Junzo Okada, Atsuya Hasegawa, Junichi A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title_full | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title_fullStr | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title_full_unstemmed | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title_short | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
title_sort | case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6952481/ https://www.ncbi.nlm.nih.gov/pubmed/31919714 http://dx.doi.org/10.1186/s40792-020-0775-6 |
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