2013 Volume 55 Issue 6 Pages 1848-1853
A 46-year-old man was admitted for the treatment of recurrent hemorrhage from esophageal varices associated with extrahepatic portal venous obstruction. He had a history of variceal rupture four times in the previous two years and had received endoscopic band ligation therapy each time. Endoscopy revealed recurrent esophageal variceal rupture, and contrast-enhanced CT showed extrahepatic portal obstruction with cavernous transformation of the portal vein with splenomegaly. Because the splenic vein was not connected to the superior mesenteric vein, but rather to the varices through the large left gastric vein, the condition was considered as “left-sided portal hypertension”, which causes difficulty in the treatment of associated esophageal varices. We performed partial splenic embolization shortly after the endoscopic injection sclerotherapy using 5% ethanolamine oleate. After the therapy, the blood flow in the left gastric vein and esophageal varices was totally blocked by a thrombus and endoscopy and EUS revealed eradication of the esophageal varices. Therefore, this combination therapy appears to be useful for the management of refractory varices.
