scholarly journals Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review

2015 ◽  
Vol 6 (4) ◽  
pp. 248 ◽  
Author(s):  
Christopher Steevens
Keyword(s):  
Portal Hypertension ◽  
Literature Review ◽  
Endoscopic Management ◽  
Variceal Bleed ◽  
Hepatic Portal

scholarly journals Endoscopic Management of Portal Hypertension

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Said A. Al-Busafi ◽  
Peter Ghali ◽  
Philip Wong ◽  
Marc Deschenes
Keyword(s):  
Portal Hypertension ◽  
Endoscopic Ultrasound ◽  
Capsule Endoscopy ◽  
Interventional Therapy ◽  
Gastric Varices ◽  
Active Management ◽  
Endoscopic Management ◽  
Diagnostic Modality ◽  
Gastroesophageal Varices ◽  
Life Threatening

Cirrhosis is the leading cause of portal hypertension worldwide, with the development of bleeding gastroesophageal varices being one of the most life-threatening consequences. Endoscopy plays an indispensible role in the diagnosis, staging, and prophylactic or active management of varices. With the expected future refinements in endoscopic technology, capsule endoscopy may one day replace traditional gastroscopy as a diagnostic modality, whereas endoscopic ultrasound may more precisely guide interventional therapy for gastric varices.

A case of systemic sclerosis complicated by idiopathic portal hypertension: case report and literature review

2006 ◽  
Vol 16 (3) ◽  
pp. 183-187 ◽  
Author(s):  
Kenji Takagi ◽  
Shinichiro Nishio ◽  
Kimiko Akimoto ◽  
Takumi Yoshino ◽  
Shinichi Kawai
Keyword(s):  
Case Report ◽  
Portal Hypertension ◽  
Systemic Sclerosis ◽  
Literature Review ◽  
Idiopathic Portal Hypertension

Endoscopic Management of Spontaneous Clival Cerebrospinal Fluid Leaks: Case Series and Literature Review

2016 ◽  
Vol 86 ◽  
pp. 470-477 ◽  
Author(s):  
Fabio Pagella ◽  
Alessandro Pusateri ◽  
Elina Matti ◽  
Cesare Zoia ◽  
Marco Benazzo ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Literature Review ◽  
Case Series ◽  
Endoscopic Management ◽  
Cerebrospinal Fluid Leaks

scholarly journals Extra Hepatic Portal Venous Obstruction in Children: Approach and Management

Mediscope ◽  
2019 ◽  
Vol 6 (2) ◽  
pp. 79-85
Author(s):  
Mukesh Khadga ◽  
Md Benzamin ◽  
ASM Bazlul Karim
Keyword(s):  
Portal Hypertension ◽  
Doppler Ultrasonography ◽  
Medical Emergency ◽  
Severe Dehydration ◽  
Venous Obstruction ◽  
Acute Variceal Bleeding ◽  
Hepatic Portal ◽  
High Index Of Suspicion ◽  
Adequate Management ◽  
Hypertension In Children

Portal hypertension in children is not uncommon and extra hepatic portal venous obstruction (EHPVO) constitute about 75% of portal hypertension. Several risk factors predispose to development of EHPVO such as neonatal sepsis, umbilical catheterization, severe dehydration, abdominal trauma or surgery etc. Common presentations are haematemesis and splenomegaly. Acute variceal bleeding is a medical emergency. Liver function is normal in extrahepatic portal hypertension unless there is portal bilopathy. High index of suspicion is the key of early diagnosis. Esophagogastrodudenoscopy is diagnostic for portal hypertension and doppler ultrasonography of portal vein confirm extra hepatic portal venous obstruction (EHPVO) in presence of thrombus and/or cavernoma. Adequate management including endotherapy, pharmacotherapy and/or surgery is an important key for better outcome. Mediscope Vol. 6, No. 2: Jul 2019, Page 79-85

scholarly journals A72 VARICEAL BLEED & PORTAL HYPERTENSIVE GASTROPATHY IN A NON-CIRRHOTIC PATIENT WITH ISOLATED SPLENOMEGALY

2020 ◽  
Vol 3 (Supplement_1) ◽  
pp. 85-86
Author(s):  
S Hasan ◽  
M Dmitriew ◽  
J Leonard
Keyword(s):  
Intensive Care ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Cirrhotic Patient ◽  
Rare Case ◽  
Treatment Plan ◽  
Venous Pressure ◽  
Retinal Dystrophy ◽  
Ct Guided ◽  
Variceal Bleed

Abstract Background Portal hypertension caused by cirrhosis is the most common etiology of esophageal varices. However, abnormalities of the spleno-portal axis in the absence of liver disease may also cause portal hypertension resulting in varices. We report a rare case of esophageal variceal bleed in a non-cirrhotic patient with isolated splenomegaly secondary to chronic G-CSF therapy. Aims This report outlines the case of a patient with Cohen Syndrome (CS) who presented with an upper gastrointestinal (GI) bleed in the setting of previously documented splenomegaly and portal hypertension. We expand on the clinical investigations, diagnosis, treatment plan and hospital course of this patient. Methods Case report, review of literature. Results A 26-year old male with previously diagnosed CS presented with large volume hematemesis and pancytopenia. CS is a rare autosomal recessive disorder. In our patient this manifested with congenital neutropenia, microcephaly, retinal dystrophy and global developmental delay. He required long term G-CSF therapy to manage chronic neutropenia and subsequently developed splenomegaly, a known side effect. The most recent MRI identified stable splenomegaly with a craniocaudal length of 23 cm, normal liver size and no radiographic evidence of cirrhosis. The imaging was also significant for gastroesophageal and splenorenal varices but no ascites or recanalization of the umbilical vein. A recent liver biopsy had shown mild pericellular fibrosis with no active liver disease or cirrhosis. In the past, the patient had declined EGD, therapeutic splenectomy or assessment of hepatic venous pressure gradient through invasive venography. His liver enzymes, bilirubin and albumin had always been within normal limits. The patient had no history of GI bleeding. Previous investigations for hematologic malignancies or myelodysplastic syndrome had been negative. Upon admission, an urgent EGD revealed active variceal bleeding in the esophagus and portal gastropathy. Given the extent of his congenital orofacial abnormalities a variceal band ligator could not be passed for appropriate intervention. The patient was transferred to the Intensive Care Unit and managed with intravenous proton pump inhibitor, octreotide, as well as transfusions of packed red blood cells, platelets and fresh frozen plasma. Within the next 48 hours, the patient underwent successful transjugular intrahepatic portosystemic shunt and CT-guided coil placements for the bleeding varices. Conclusions This is a rare case of variceal bleed in a non-cirrhotic patient with portal hypertension from iatrogenic splenomegaly. While there are previous reports of spontaneous splenic rupture secondary to G-CSF therapy we are the first to report variceal bleed as a complication. This is a life-threatening consequence that requires urgent intervention and intensive care. Funding Agencies None

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

Tu1010 Noninvasive Methods in Predicting Large Esophageal Varices in Pediatric Patients With Intra-Hepatic Portal Hypertension, According to Child-Pugh Classification

2013 ◽  
Vol 144 (5) ◽  
pp. S-1031 ◽  
Author(s):  
Marina R. Adami ◽  
Cristina Targa Ferreira ◽  
Vania Hirakata ◽  
Sandra Maria G. Vieira ◽  
Carlos O. Kieling
Keyword(s):  
Portal Hypertension ◽  
Esophageal Varices ◽  
Pediatric Patients ◽  
Noninvasive Methods ◽  
Hepatic Portal
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