Abstract
A-60-year-old man with liver cirrhosis who had undergone four previous surgeries, namely, distal gastrectomy, operation for ileus and hepatectomy twice for hepatocellular carcinoma was admitted to our hospital with melena and hemorrhagic preshock. Upper gastrointestinal endoscopy failed to reveal the source of bleeding. However, contrast-enhanced abdominal CT suggested the presence of varices in the small intestine, continuous with the right inferior epigastric vein as the collateral efferent? vessel on the abdominal wall. Active bleeding from these varices was strongly suspected and an emergency laparotomy was performed. As the findings were compatible with the preoperative CT findings, the right inferior epigastric artery and vein were both ligated, and partial resection of the adherent small intestine was performed. The postoperative course was uneventful. The possibility of ruptured small intestinal varices should also be considered in patients with portal venous hypertension presenting with gastrointestinal bleeding, especially after a previous laparotomy.
