2007 Volume 27 Issue 7 Pages 957-961
PURPOSE : Bleeding ectopic varices can be difficult to manage. We report our experience of 13 cases with bleeding ectopic varices of the small intestine. METHODS : From 1982 to 2006, 13 portal hypertensive patients had bleeding ectopic small intestinal varices. The location of the varices was an esophageal jejunal anastomosis (n = 3) and jejuno-jejunal anastomosis (n = 1) after total gastrectomy, gastric jejunal anastomosis after partial gastrectomy (n = 1), hepatico-jejunal anastomosis (n = 1), and small intestine (n = 7). RESULTS : Endoscopic injection sclerotherapy (EIS) was performed in 3 patients, and percutaneous transhepatic obliteration (PTO) was performed in 2 patients. In 1 patient surgical resection of the small intestine was performed, and in the remaining 6 patients balloon-occluded retrograde transvenous obliteration (B-RTO) was performed. A beta-blocker was administered in 1 patient. The bleeding was controlled in all patients. Preoperative MD-CT clearly showed ectopic varices in 9 patients who underwent EIS or B-RTO, and then postoperative MD-CT confirmed the disappearance of the variceal blood flow. Rebleeding occurred in 2 patients who underwent PTO. CONCLUSION : The present study demonstrates that bleeding from ectopic varices could be managed relatively safely by embolization of ectopic small intestinal varices with EIS or B-RTO with a low incidence of rebleeding.
