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Ectopic variceal bleeding after hepatobiliary surgery: A case report.

Yang Tai1,2, Huan Tong1, Bo Wei1

  • 1Department of Gastroenterology.

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|March 3, 2021
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Summary

Jejunal varices, a rare complication of portal hypertension after hepatobiliary surgery, can cause severe gastrointestinal bleeding. Portal venous angioplasty successfully treated a patient with jejunal varices, preventing further bleeding.

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Interventional Radiology

Background:

  • Jejunal varices are uncommon in portal hypertension and pose diagnostic and therapeutic challenges.
  • This case highlights jejunal varices as a cause of gastrointestinal bleeding following hepatobiliary surgery.

Observation:

  • A 69-year-old male experienced recurrent massive gastrointestinal bleeding 2 years after partial right hepatectomy and cholangiojejunostomy.
  • Despite treatment for esophageal varices, persistent melena indicated an alternative bleeding source.
  • Diagnosis revealed jejunal varices secondary to portal venous stenosis post-surgery.

Findings:

  • Portal venous angioplasty with balloon dilation and stent implantation was performed.
  • The patient remained free of gastrointestinal bleeding post-intervention during follow-up.

Implications:

  • Hepatopancreatobiliary surgery can precipitate jejunal varices.
  • A combination of capsule endoscopy, contrast-enhanced CT, and portal venography aids in diagnosing jejunal varices.
  • Transcatheter angioplasty offers a safe and effective treatment for select cases of jejunal varices.