A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction
| Autor: | Seiichi Goda, Chikato Koga, Toshinori Sueda, Atsuya Okada, Haruna Furukawa, Tae Matsumura, Naoki Shinno, Junzo Shimizu, Junichi Hasegawa, Ryohei Kawabata, Shingo Noura |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Percutaneous Proximal gastrectomy medicine.medical_treatment PTO lcsh:Surgery Case Report Mesenteric Vein 03 medical and health sciences 0302 clinical medicine Esophageal varices Gastrointestinal perforation Ascites Medicine business.industry lcsh:RD1-811 medicine.disease Surgery 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Gastrectomy Azygos vein medicine.symptom Esophagojejunal varices business Varices |
| Zdroj: | Surgical Case Reports, Vol 6, Iss 1, Pp 1-5 (2020) Surgical Case Reports |
| ISSN: | 2198-7793 |
| Popis: | Background The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration. Case presentation A 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days. Conclusion PTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full text from SpringerLink