Porto-gastric fistula from penetration of coil from gastric varix after TIPS procedure for bleeding gastric varices

This case reports a iatrogenic gastric fistula due to external draining successfully closed by using an over- the-scope clip. A 50-year old patient with a history of acute pancreatitis, segmental portal hypertension and splenectomy for splenic rupture, with long-term external drainage for a low volume pancreatic fistula, was referred to our hospital. The patient noticed the occurrence of a sudden increase of the drain flow and the immediate drainage of ingested liquid, with no fever or pain. An upper gastrointestinal endoscopy evidenced the gastric fistula with the presence of the drain inside the stomach near a gastric varix. The surgical approach was inappropriate due to bleeding risk. An over-the-scop clip was placed succeeding to stop the gastric flow. The external fistula closed one week later.

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A Noninvasive Imaging Technique to Evaluate Therapeutic Efficacy after Injection of n-Butyl-2-cyanoacrylate Tissue Adhesive into Gastric Varices: A Case Report

Canadian Journal of Gastroenterology ◽

10.1155/2009/182082 ◽

2009 ◽

Vol 23 (6) ◽

pp. 412-414 ◽

Cited By ~ 1

Author(s):

Bret J Spier ◽

Andrew J Taylor ◽

Patrick R Pfau ◽

Adnan Said ◽

Deepak V Gopal

Keyword(s):

Imaging Technique ◽

Gastric Varix ◽

Gastric Varices ◽

Tissue Adhesive ◽

Upper Gastrointestinal Hemorrhage ◽

Computed Tomographic ◽

Repeat Endoscopy ◽

Noninvasive Imaging Technique ◽

Treatment Adequacy ◽

Upper Gastrointestinal

A novel use of multidetector computed tomographic intravenous (MDCT IV) portography in the evaluation of gastric varices treated with tissue adhesive is described. A 55-year-old man presented with upper gastrointestinal hemorrhage as a result of bleeding gastric varices. The patient was stabilized and the gastric varices were treated with n-butyl-2-cyanoacrylate (two injections, total 7.5 mL). MDCT IV portography performed after injection revealed thrombosis of all but one of the submucosally based gastric varices. The endoscopist who performed repeat endoscopy three weeks later was then able to direct therapy at the remaining patent submucosally based gastric varix. This represents the first reported use of MDCT IV portography in the evaluation of treatment adequacy in a patient with gastric varices treated with n-butyl-2-cyanoacrylate.

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Balloon-Occluded Retrograde Transvenous Obliteration (BRTO): A Novel Method of Obliterating Gastric Varices. Report of Six Cases and Review of Literature

Journal of Advances in Internal Medicine ◽

10.3126/jaim.v9i2.31049 ◽

2020 ◽

Vol 9 (2) ◽

pp. 89-93

Author(s):

Ajit Thapa ◽

Dinesh Koirala ◽

Rahul Pathak ◽

Dinesh Chataut ◽

Sashi Sharma ◽

...

Keyword(s):

Balloon Catheter ◽

Invasive Procedure ◽

Gastric Varix ◽

Gastric Varices ◽

Minimal Invasive ◽

Balloon Occlusion ◽

Endoscopic Variceal Ligation ◽

Review Of Literature ◽

Gastroesophageal Varices ◽

Novel Method

Portal hypertension results in various complications, gastroesophageal varices being one of them. Although less common than esophageal varices, gastric varices are difficult to obliterate and carry a higher mortality rate when bleeding occurs. They are less amenable to sclerotherapy, endoscopic variceal ligation. Balloon-Occluded Retrograde Transvenous Obliteration (BRTO) has been developed as a minimal invasive procedure to obliterate gastric varices. BRTO is an endovascular procedure where a balloon catheter is inserted into a draining vein of gastric varix, and the sclerosant can be injected into the varices through the catheter during balloon occlusion. We report six cases where BRTO was done for gastric varices obliteration.

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Current Approaches to the Treatment of Gastric Varices: Glue, Coil Application, TIPS, and BRTO

Medicina ◽

10.3390/medicina55070335 ◽

2019 ◽

Vol 55 (7) ◽

pp. 335 ◽

Cited By ~ 6

Author(s):

Goral ◽

Yılmaz

Keyword(s):

Esophageal Varix ◽

Esophageal Varices ◽

Portal Pressure ◽

Gastric Varix ◽

Clinical Problem ◽

Gastric Varices ◽

Treatment Modalities ◽

Anatomic Site ◽

Efficient Treatment ◽

Varix Pressure

Gastric varices are less common than esophageal varices, and their treatment is quite challenging. Gastric varix bleedings (GVB) occur less frequently than esophageal varix (EV) bleedings and represent 10% to 30% of all variceal bleedings. They are; however, more severe and are associated with high mortality. Re-bleeding may occur in 35% to 90% of cases after spontaneous hemostasis. GV bleedings represent a serious clinical problem compared with esophageal varices due to their location. Sclerotherapy and band ligation, in particular, are less effective. Based on the anatomic site and location, treatment differs from EV and is categorized into two groups (i.e., endoscopic or radiologic treatment). Surgical management is used less frequently. Balloon-occluded retrograde transvenous obliteration (BRTO) and cyanoacrylate are safe but there is a high risk of re-bleeding. Portal pressure elevates following BRTO and leads to worsening of esophageal varix pressure. Other significant complications may include hemoglobinuria, abdominal pain, fever, and pleural effusion. Shock and atrial fibrillation are major complications. New and efficient treatment modalities will be possible in the future.

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Hepatic Arterioportal Fistula Presenting as Gastric Variceal Hemorrhage

Journal of Gastrointestinal and Liver Diseases ◽

10.15403/jgld.2014.1121.232.brk1 ◽

2014 ◽

Vol 23 (2) ◽

pp. 211-214 ◽

Cited By ~ 2

Author(s):

Bobby R. Kakati ◽

Mark R. Pedersen ◽

Steve Y. Chen ◽

Kevin S. Hirsch ◽

Paul J. Berggreen ◽

...

Keyword(s):

Liver Biopsy ◽

Portal Vein ◽

Hepatic Artery ◽

Clinical Symptoms ◽

Gastric Varix ◽

Gastric Varices ◽

Variceal Hemorrhage ◽

Percutaneous Liver Biopsy ◽

Arterioportal Fistula ◽

Arterial Blood

Hepatic arterioportal fistulae (APF) are abnormal communications between the hepatic artery and the portal vein. In this report, we present the second case in the literature of a symptomatic APF presenting as a gastric variceal bleeding. A 55-year-old female presented to our facility with hematemesis. Upper endoscopy revealed a bleeding gastric varix. A computed tomography scan identified a large left hepatic lobe APF between the left hepatic artery and the left portal vein. Through angiography coil embolization was performed and with resultant loss of arterial flow, the APF was decompressed. On hospital day 3, the patient developed new melena. Portovenogram was performed and a TIPS stent was deployed. The patient subsequently did well. Hepatic arterioportal fistulae can result in portal hypertension secondary to arterial blood flowing directly into the portal vein bypassing the hepatic sinusoids. Iatrogenic causes (e.g. percutaneous liver biopsy) represent more than 50% of published cases of APFs. Most APFs resolve spontaneously as they are small and peripherally located. In rare instances, when APFs are centrally located, clinical symptoms develop. There have been 30 reported cases of symptomatic intrahepatic APFs following percutaneous liver biopsy. Of those, only one case presented as a gastric variceal bleed. Digital subtraction angiography is the gold standard in the diagnosis and treatment of APFs. In addition to initial embolization, we elected to treat the patient with TIPS due to the magnitude of her bleed. Although rare, intrahepatic APF should be kept on the differential of a patient presenting with isolated gastric varices.

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Unexpected diagnosis in a patient with a liver mass: A case report

african journal of gastroenterology and hepatology ◽

10.52378/asym7783 ◽

2019 ◽

Vol 1 (1) ◽

pp. 53-63

Author(s):

Mohamed Hassan Ibrahim

Keyword(s):

Portal Hypertension ◽

Gastric Varix ◽

Gastric Varices ◽

Complete Disappearance ◽

Liver Mass ◽

Elevated Liver Enzymes ◽

High Prevalence ◽

High Incidence ◽

Hepatic Sarcoidosis ◽

Granulomatous Formation

Sarcoidosis is a rare inflammatory disease. It is characterized by granulomatous formation. The liver is the second most common site of involvement after the lung. Sarcoidosis of the liver is usually asymptomatic. Symptomatic cases can present with jaundice, itching, elevated liver enzymes, and in rare situations, the development of portal hypertension. We, at this moment, submit a case of liver sarcoidosis in a patient with liver cirrhosis that presented with upper gastrointestinal bleeding. Upper digestive endoscopy revealed gastric varices. Ultrasonography of the abdomen revealed a liver mass that was suspicious for hepatocellular carcinoma. There is no nay cause of gastric varix in this patient apart from hepatic sarcoidosis (portal hypertension). Treatment of the patient with corticosteroids leads to the complete disappearance of the liver mass. Despite the high incidence of HCC in Egypt due to the high prevalence of HCV infection, it is crucial to search for the rare causes of hepatic masses. Keywords: liver mass; sarcoidosis, gastric varix

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