Successful treatment of refractory F₀ type varices hemorrhage with idiopathic portal hypertension via transcatheter left gastric arterial embolization

Abstract

A 55-year-old male with no history of health problems was admitted to another hospital because of hematemesis in October 2000. Upper gastrointestinal endoscopy revealed esophageal variceal bleeding. Endoscopic injection sclerotherapy and endoscopic variceal ligation were performed. However, hematemesis occurred three times despite repeated treatment. The patient was admitted to our hospital in April 2004 because of rebleeding. Endoscopic treatment was not possible, thus surgical treatment was performed. Based on the laboratory and histopathological findings, idiopathic portal hypertension was thought to be the cause of esophageal varices. In May 2006, the patient vomited blood and was admitted again. F₀ form varices with positive for red color sign were observed in the lower esophagus. Abdominal angiography showed sudare-shaped blood vein (palisade vein) branching from the left gastric artery and Transcatheter Arterial Embolization (TAE) was performed. Hemostasis was achieved immediately after TAE, and rebleeding has not been experienced for over one year.