Abstract
The patient was a 69-year-old man with a chief complaint of tarry stool. Upper gastrointestinal endoscopy revealed no abnormalities. His melena subsided after fasting. However, once oral ingestion was resumed, the melena recurred and anemia was persistent. Thus, CT was performed, raising the suspicion of small bowel varices. Angiography revealed duodenojejunal varices, as well as obstruction of the superior mesenteric, portal, and splenic veins. The duodenojejunal varices were confirmed by small bowel endoscopy, and the patient was referred to our department. Endoscopic treatment was not possible due to multiple varices affecting the jejunum as well. In addition, because unexplained extrahepatic portal obstruction was noted, partial duodeno-jejunectomy with vascular excision was highly likely to result in postoperative hepatic failure. For this reason, open surgery was performed for variceal embolization via the ileal vein. At more than 5 years after embolization, no sign of relapse (e.g., melena) has been noted. However, in view of reports on recanalization of embolized collaterals, this patient should continue to be followed closely.
