scholarly journals Transjugular intrahepatic portosystemic stent shunt placement and embolization for hemorrhage associated with rupture of anorectal varices

2018 ◽  
Vol 46 (4) ◽  
pp. 1666-1671 ◽  
Author(s):  
Xiuyan Wu ◽  
Wei Xuan ◽  
Lei Song
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Variceal Bleeding ◽  
Treatment Guidelines ◽  
Specific Treatment ◽  
Autoimmune Liver Disease ◽  
Timely Manner ◽  
Ectopic Varices ◽  
Life Threatening ◽  
Anorectal Varices

Portal hypertension can lead to ectopic varices, which occur most frequently in the rectum. Rectal variceal bleeding in patients with portal hypertension is rare but can be life-threatening if not diagnosed and treated in a timely manner. However, no specific treatment guidelines have been established for rectal variceal bleeding. We herein report a case involving a woman with portal hypertension due to autoimmune liver disease who was successfully treated with a transjugular intrahepatic portosystemic stent shunt and variceal embolization. We recommend treatment of refractory ectopic variceal bleeding with a transjugular intrahepatic portosystemic stent shunt in combination with embolization.

Hepatic venous-portal gradient (HVPG) measurement: pearls and pitfalls

2021 ◽  
pp. 20210061
Author(s):  
Qiqi Lu ◽  
Sum Leong ◽  
Kristen Alexa Lee ◽  
Ankur Patel ◽  
Jasmine Ming Er Chua ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Hepatic Encephalopathy ◽  
Risk Stratification ◽  
Variceal Bleeding ◽  
Gold Standard ◽  
Crucial Role ◽  
Venous Pressure ◽  
Common Cause ◽  
Life Threatening ◽  
Selection And Assessment

Hepatic venous pressure gradient (HVPG) is the gold-standard for measurement of portal hypertension, a common cause for life-threatening conditions such as variceal bleeding and hepatic encephalopathy. HVPG also plays a crucial role in risk stratification, treatment selection and assessment of treatment response. Thus recognition of common pitfalls and unusual hepatic venous conditions is crucial. This article aims to provide a radiographical and clinical guide to HVPG with representative clinical cases.

scholarly journals Endovascular and Percutaneous Treatment of Pediatric Portosystemic Varices: A Case Review

2019 ◽  
Vol 03 (03) ◽  
pp. 214-226
Author(s):  
Alexander Dabrowiecki ◽  
Eric J. Monroe ◽  
Rene Romero ◽  
Anne E. Gill ◽  
C. Matthew Hawkins
Keyword(s):  
Portal Hypertension ◽  
Small Bowel ◽  
Endovascular Treatment ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
Percutaneous Treatment ◽  
Roux Limb ◽  
Case Review ◽  
Gastroesophageal Varices ◽  
Ectopic Varices

AbstractPortal hypertension is a significant cause of morbidity and mortality in pediatric patients. Complications of portal hypertension include development of portosystemic varices. The most common type of portosystemic varices are gastroesophageal varices; however, other ectopic varices can also be a cause of recurrent, life-threatening gastrointestinal bleeding. Problematic ectopic varices include isolated gastric, anorectal, small bowel, roux-limb, and stomal varices. There are no standardized treatment guidelines on how to manage ectopic varices in children; however, new innovations in endovascular treatment options provide potential therapeutic alternatives when varices are refractory to conventional therapy. This review provides a case-based literature review for endovascular treatment of isolated gastric, anorectal, small bowel, roux-limb, and stomal ectopic varices in children (age 0-9 years) and adolescents (age 10-19 years).

scholarly journals A174 RARE BUT DEADLY: AN APPROACH TO MANAGEMENT OF DUODENAL VARICEAL HEMORRHAGE

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 39-41
Author(s):  
M Dahiya ◽  
M Tomaszewski ◽  
G Ou ◽  
A Ramji
Keyword(s):  
Interventional Radiology ◽  
Case Report ◽  
Portal Hypertension ◽  
Literature Review ◽  
Gastrointestinal Bleeding ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Cyanoacrylate Glue ◽  
Duodenal Varices ◽  
Ectopic Varices

Abstract Background Common etiologies of upper gastrointestinal bleeding (UGIB) in cirrhotic patients with portal hypertension include gastroesophageal varices (GOV), portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE). Less commonly, patients with portal hypertension develop varices in ectopic sites, including the rectum, biliary tree and duodenum. Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Aims To describe the management of duodenal variceal hemorrhage. Methods A case report and literature review was performed. Results Case report: We present a case of recurrent UGIB in a 59-year-old male with decompensated cirrhosis due to non-alcoholic steatohepatitis (CP-C; Meld 14). Initial endoscopy was negative for GOV, peptic ulcer, PHG, and GAVE, but an erosion over a mucosal bulge in the third segment of the duodenum was identified, raising possibility of vascular malformation versus ectopic varix. There was active bleeding after water provocation, so clips were deployed for hemostasis. CT imaging showed mesenteric venous collaterals abutting the duodenum, again raising possibility of duodenal varix, which was ultimately confirmed by endoscopic ultrasound (EUS). Patient had recurrent overt bleeding despite beta-blockage for prophylaxis, endoscopic clipping on four separate occasions, attempted angioembolization by interventional radiology, and cyanoacrylate glue. Transjugular intrahepatic porto-systemic shunt (TIPS) was not possible due to portal vein occlusion, so he underwent EUS-guided cyanoacrylate glue a second time. Literature review: Ectopic varices are rare, contributing to 1–5% of all variceal bleeding, of which 17% is from duodenal varices. Duodenal variceal hemorrhage can lead to hemorrhagic shock, and is potentially life threatening, with quoted mortality rates of 40%. Unfortunately, duodenal varices can be difficult to identify. Diagnosis is often delayed due to a combination of lower awareness and endoscopic challenges given the unusual serosal and submucosal location. Evidence-based guidelines for the management of ectopic varices are limited. For this reason, our current management strategies rely heavily on local expertise. Splanchnic vasoconstrictor medication, endoscopic ligation, EUS guided gluing, interventional radiology guided embolization, TIPS, balloon retrograde transvenous obliteration and surgical shunts are potential therapeutic options to manage the acutely bleeding varix. Following a variceal bleed, liver transplantation should be considered in eligible patients with no other contraindications. Conclusions Duodenal varices are a rare, potentially fatal, and underrecognized cause of gastrointestinal bleeding in patients with portal hypertension. Definitive therapy currently relies upon local expertise in the absence of clear guideline-based therapy. Funding Agencies None

Life-threatening Variceal Bleeding from Chronic Schistosomal Liver Disease

2012 ◽  
Vol 107 ◽  
pp. S401
Author(s):  
Thomas Tran ◽  
Robert Watson ◽  
Gerald Johnson ◽  
Birendra Lal ◽  
Brian Mogaka
Keyword(s):  
Liver Disease ◽  
Variceal Bleeding ◽  
Life Threatening

scholarly journals Enteroscopic Management of Ectopic Varices in a Patient with Liver Cirrhosis and Portal Hypertension

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
G. A. Watson ◽  
A. Abu-Shanab ◽  
R. L. O’Donohoe ◽  
M. Iqbal
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Early Detection ◽  
Gastrointestinal Bleeding ◽  
Alcoholic Liver Disease ◽  
Significant Morbidity ◽  
Push Enteroscopy ◽  
Ectopic Varices ◽  
Occult Gastrointestinal Bleeding

Portal hypertension and liver cirrhosis may predispose patients to varices, which have a propensity to bleed and cause significant morbidity and mortality. These varices are most commonly located in the gastroesophageal area; however, rarely ectopic varices may develop in unusual locations outside of this region. Haemorrhage from these sites can be massive and difficult to control; thus early detection and management may be lifesaving. We present a case of occult gastrointestinal bleeding in a patient with underlying alcoholic liver disease where an ectopic varix was ultimately detected with push enteroscopy.

Management of Gastric and Ectopic Varices: The Endoscopist's Perspective

2020 ◽  
Vol 04 (02) ◽  
pp. 110-121
Author(s):  
Zachary Henry
Keyword(s):  
Portal Hypertension ◽  
Case Reports ◽  
Rare Complication ◽  
Treatment Options ◽  
Specific Treatment ◽  
Case Series ◽  
Vascular Anatomy ◽  
Rectal Varices ◽  
Ectopic Varices ◽  
Definitive Therapy

AbstractGastric and Ectopic varices are a rare complication of portal hypertension and represent a complex, heterogeneous system of vascular shunts. Bleeding from these shunts can be severe and life-threatening, with poorly standardized treatment algorithms to follow in their management. When bleeding occurs, it is important to follow standard diagnostic procedures for portal hypertensive bleeding and always obtain imaging of the underlying vascular anatomy to help guide therapy. Potential treatment methods will depend on these imaging findings as well as the location of the varix within the gastrointestinal tract. While gastric varices have more data to support specific treatment options, duodenal and rectal varices have only case reports and case series to guide their care. In addition, stomal varices are a very rare complication of portal hypertension and have limited data to support any one treatment modality. Gastric and ectopic varices are best approached in a multidisciplinary fashion after discussion with hepatologists and interventional radiologists to overcome the uncertainty in choosing a definitive therapy.

scholarly journals A study on non endoscopic predictors of esophageal varices and portal hypertension in chronic liver disease

2020 ◽  
Vol 11 (SPL2) ◽  
pp. 228-234
Author(s):  
Karthick M ◽  
Prabakaran P T ◽  
Rajendran K ◽  
Gowrishankar A ◽  
Halleys Kumar E ◽  
...  
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Chronic Liver ◽  
First Episode ◽  
Oesophageal Varices ◽  
Screening Endoscopy

Portal hypertension is associated with liver cirrhosis and esophageal varices is a common complication. Cirrhotic liver increases resistance to the passage of blood and thereby increased splanchnic blood flow secondary to vasodilation. Prevalence of portal hypertension varies from 50-60% in patients with liver cirrhosis. The first episode of variceal bleeding causes mortality, which ranges from 40-70%. All cirrhotic patients should be screened for the oesophageal varices according to  Baveno III consensus conference on portal hypertension and recommendation for endoscopy is at 2-3 years intervals in patients without varices and at 1-2 years interval in patients with small varices in order to evaluate the development or variceal progression. But this is questionable as endoscopy is an invasive procedure and also cost-effective. Only 9-36% of patients with cirrhosis were found to have varices on screening endoscopy. Non-invasive assessment of variceal bleeding with good predictivity includes biochemical, clinical and ultrasonographic parameters. Thus unnecessary intervention is avoided and at the same time, the patients at risk of bleeding are also not missed. This study emphasizes the need for an annual ultrasonogram examination as a part of a surveillance program for screening of oesophageal varices in patients of chronic liver disease.

scholarly journals Outcome of Band Ligation in Esophageal Varices of Bangladeshi Children: A Tertiary Centre Experience

2017 ◽  
Vol 41 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Salahuddin Mahmud ◽  
Syed Shafi Ahmed ◽  
Jahida Gulshan ◽  
Farhana Tasneem ◽  
Madhabi Baidya
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Variceal Bleeding ◽  
Clinical Situation ◽  
Gastric Varices ◽  
Band Ligation ◽  
Tertiary Centre ◽  
Life Threatening ◽  
Common Etiology ◽  
One Year

Background: Variceal bleeding is often a life threatening clinical situation in infants and children. Band ligation is the main endoscopic treatment for esophageal varices.Objective: To see the outcome of band ligation of esophageal varices in extra-hepatic and hepatic cases of portal hypertension.Methods: This prospective study was done in the Department of Pediatric Gastroenterology, Hepatology & Nutrition, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh on 40 consecutive cases of esophageal varices enrolled from April, 2014 to March 2016. Every case was treated with band ligation followed by tab. propranolol. Cases were followed up for a minimum period of one year after the band ligation.Results: Age of the children was 2-12 years with mean age of 7.2±4.3 years and male:female ratio was 1.5:1. Out of 40 children, 32 (80%) were pre-hepatic and 8 (20%) hepatic (chronic liver disease with portal hypertension) causes. Only 1 session required in 50% pre-hepatic cases and multiple (2-3) sessions required in hepatic (100%) cases. Almost same number of band (average 2-3) required in every session of both cases. Grade-II esophageal varices with red sign were more common in prehepatic cases & severity of grading much more (grade-III & IV) in hepatic cases. Gastric varices were more common in hepatic (50%) cases than extra-hepatic (12.5%) cases. Recurrence of bleeding occurred in all hepatic (100%) cases and half (50%) of the pre-hepatic cases. Early re-bleeding was more common in hepatic (75%) cases & late re-bleeding in both pre-hepatic (43.7%) & hepatic (100%) cases. Minimal side effect like discomfort (10%) & Nausea (10%) were present after the procedure.Conclusion: Pre-hepatic was the most common etiology of portal hypertension in studied children. Fewer sessions were required in pre-hepatic cases than in hepatic cases. Severity of grading, re-bleeding & associated gastric varices were more common in hepatic cases. Band ligation was found to be the treatment of choice for the control of acute variceal bleeding and prevention of re-bleeding with less complications.Bangladesh J Child Health 2017; VOL 41 (1) :28-33

Emergent treatment of variceal bleeding in two infants

2008 ◽  
Vol 49 (8) ◽  
pp. 951-954 ◽  
Author(s):  
A. Park ◽  
W. Cwikiel
Keyword(s):  
Liver Cirrhosis ◽  
Portal Hypertension ◽  
Portal Vein ◽  
Biliary Atresia ◽  
Portal Vein Thrombosis ◽  
Variceal Bleeding ◽  
The Other ◽  
Bleeding Control ◽  
Vein Thrombosis ◽  
Life Threatening

Two infants with portal hypertension were treated on an emergency basis for life-threatening uncontrollable variceal bleeding. One 9-month-old girl had portal vein thrombosis, and the other 28-months-old girl had liver cirrhosis secondary to biliary atresia. Following percutaneous transhepatic embolization of the varices, successful bleeding control was achieved in both patients.

scholarly journals Regression of portal hypertension: underlying mechanisms and therapeutic strategies

2021 ◽  
Vol 15 (1) ◽  
pp. 36-50
Author(s):  
Sonia Selicean ◽  
Cong Wang ◽  
Sergi Guixé-Muntet ◽  
Horia Stefanescu ◽  
Norifumi Kawada ◽  
...  
Keyword(s):  
Portal Hypertension ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Pharmacological Therapy ◽  
Chronic Liver ◽  
Life Threatening ◽  
Clinical Models ◽  
Blood Inflow ◽  
Underlying Mechanisms ◽  
Intrahepatic Vascular Resistance

AbstractPortal hypertension is the main non-neoplastic complication of chronic liver disease, being the cause of important life-threatening events including the development of ascites or variceal bleeding. The primary factor in the development of portal hypertension is a pathological increase in the intrahepatic vascular resistance, due to liver microcirculatory dysfunction, which is subsequently aggravated by extra-hepatic vascular disturbances including elevation of portal blood inflow. Evidence from pre-clinical models of cirrhosis has demonstrated that portal hypertension and chronic liver disease can be reversible if the injurious etiological agent is removed and can be further promoted using pharmacological therapy. These important observations have been partially demonstrated in clinical studies. This paper aims at providing an updated review of the currently available data regarding spontaneous and drug-promoted regression of portal hypertension, paying special attention to the clinical evidence. It also considers pathophysiological caveats that highlight the need for caution in establishing a new dogma that human chronic liver disease and portal hypertension is reversible.

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