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Massive gastrointestinal bleeding from jejunal varices.

Y E Joo1, H S Kim, S K Choi

  • 1Department of Internal Medicine, Chonnam National University Medical School, Kwangju, Korea.

Journal of Gastroenterology
|November 4, 2000
PubMed
Summary

This case study details massive gastrointestinal bleeding caused by jejunal varices in a patient with a history of liver cirrhosis. Surgical intervention confirmed and treated the bleeding varices.

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Area of Science:

  • Gastroenterology
  • Hepatology
  • Surgical Gastroenterology

Background:

  • Massive gastrointestinal bleeding (GIB) is a critical condition requiring prompt diagnosis and management.
  • Jejunal varices, though rare, can be a significant source of GIB, particularly in patients with portal hypertension or altered anatomy.
  • Previous abdominal surgeries can predispose patients to altered venous drainage and variceal formation.

Observation:

  • A 54-year-old female presented with acute melena and hematochezia.
  • Initial investigations including upper endoscopy and colonoscopy did not reveal the source of bleeding.
  • Technetium-99m-labeled red blood cell scan indicated active bleeding in the proximal small bowel.
  • Abdominal aortic angiography identified mesenteric varices but no active bleeding site.

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Findings:

  • Emergency laparotomy revealed micronodular liver cirrhosis and a Roux-en-Y anastomosis.
  • Numerous collateral variceal vessels were identified in the jejunal limb, communicating with the liver and abdominal wall.
  • Histological examination confirmed submucosal jejunal veins with mucosal erosion as the source of bleeding.

Implications:

  • This case highlights jejunal varices as a potential cause of massive GIB in patients with complex surgical history and liver disease.
  • Diagnostic challenges in identifying obscure GIB sources necessitate a multimodal imaging approach.
  • Surgical management, including resection of affected jejunum, can be effective in controlling refractory jejunal variceal bleeding.