Open AccessJejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage
Author(s) -
Caleb Heiberger,
Tej I Mehta,
Douglas Yim
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-228680
Subject(s) - medicine , varices , bleed , portal hypertension , pancreaticoduodenectomy , gastric varices , radiology , percutaneous , pancreatitis , portal vein thrombosis , stenosis , decompression , portography , surgery , gastroenterology , pancreas , portal vein , cirrhosis
A 78-year-old woman presented with melaenic stool and severe anaemia 4 years after a pancreaticoduodenectomy for adenocarcinoma of the pancreas. Initial workup revealed haemorrhage from the choledochojejunostomy site. Despite multiple endoscopic clips to the region, bleeding reoccurred multiple times over a period of several months. Due to ongoing haemorrhage, her case was urgently presented at the hospital's multidisciplinary hepatobiliary conference. The contrast-enhanced abdominal CT revealed severe stenosis of the extrahepatic portal vein and large afferent jejunal varices at the choledochojejunostomy, suspected as the cause of her persistent bleed. The recommendation was a percutaneous transhepatic approach for stenting of the portal vein stenosis that resulted in rapid decompression of the jejunal varices and control of her haemorrhage.