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Esophageal Varices-II: Clinical Features and Management01:28

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Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
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The clinical manifestations of gastritis can vary depending on the cause and type of gastritis, but some common symptoms may include the following.
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Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...
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The vascular phase, also known as vasospasm, is the initial stage of hemostasis, crucial for preventing excessive bleeding when a blood vessel is injured. After a vessel is cut, nerves in the damaged area trigger pain and other sensory impulses. Simultaneously, the smooth muscles in the vessel wall contract, resulting in a vascular spasm. This contraction reduces the vessel's diameter at the injury site, slowing or stopping blood loss through the vessel wall. Vascular spasms typically last...
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Application of Hemostatic Devices in Laparoscopic Hepatectomy
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Halting the haematochezia.

Meera Mistry1, Joseph Fiske1, Tehreem Chaudhry1

  • 1Department of Gastroenterology and Hepatology, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.

Frontline Gastroenterology
|April 29, 2021
PubMed
Summary

A rare case of rectal varices bleeding in a patient with primary sclerosing cholangitis (PSC) was successfully treated using coil-assisted retrograde transvenous obliteration, an effective interventional radiology technique.

Keywords:
bleedinginterventional radiologyportal hypertensionprimary sclerosing cholangitis

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Area of Science:

  • Gastroenterology
  • Interventional Radiology
  • Vascular Surgery

Background:

  • Primary sclerosing cholangitis (PSC) can lead to portal hypertension and gastrointestinal varices.
  • Rectal varices are an uncommon but serious complication, often presenting with significant bleeding.

Observation:

  • An elderly patient with PSC presented with severe rectal bleeding from rectal varices.
  • Endoscopic therapy with histoacryl glue failed to control the bleeding.
  • Surgical and transjugular intrahepatic portosystemic shunt (TIPS) options were considered high-risk.

Findings:

  • Coil-assisted retrograde transvenous obliteration (CARTO) was successfully employed via interventional radiology.
  • This endovascular embolization technique effectively achieved hemostasis.

Implications:

  • CARTO offers a minimally invasive and effective alternative for managing refractory rectal variceal bleeding.
  • It presents advantages over traditional balloon occlusion methods, including reduced procedure time and lower risk of complications.