Ruptured Ileal Varices Diagnosed Using Double-balloon Enteroscopy and Successfully Treated by Surgery

Abstract

A 49-year-old woman with a history of hepatitis B and hepatocellular carcinoma was admitted to our hospital because of melena and emesis. She had undergone hepatectomy, transarterial emobolization, and radiofrequency ablation for hepatocellular carcinoma, endoscopic therapies for esophageal varices, and hysterectomy for uterus myoma. Retrograde double-balloon enteroscopy revealed ruptured ileal varices. Enhanced CT and angiography were not performed because of her allergic history to iodinated contrast material. The patient underwent partial resection of the ileum and has been free of bleeding for 11 months. When diagnosing ileal varices, past histories of abdominal surgery and treatment for esophageal varices could be helpful. Over the last decade, double-balloon enteroscopy and capsule endoscopy have been commonly used for diagnosis of small-bowel lesions due to better diagnostic capability compared with conventional examinations such as CT and angiography. Surgery is the most reliable treatment, and it is important to understand the hemodynamic status of ileal varices to ensure surgical safety.