Ruptured duodenal varices successfully treated with balloon-occluded retrograde transvenous obliteration : report of a case

Abstract

A 66-year-old man with alcoholic cirrhosis was admitted to our hospital with fatigue and weakness for the last few days. He had recent on set of melena with severe anemia. Emergent upper gastrointestinal endoscopy revealed dark-red colored tense varices in the descending portion of duodenum. Multidimensional computed tomography (MDCT) demonstrated the duodenal varices (DV) supplied by the posterior superior pancreaticoduodenal vein (PSPDV) and drained into right testicular vein. We performed balloon-occluded retrograde transvenous obliteration (BRTO) because the ruptured DV were the cause of melena. A balloon catheter was inserted via the right femoral vein and wedged into the rt. testicular vein. Digital subtraction angiography showed DV supplied by the PSPDV and DV collaterals. The collateral veins were embolized with microcoils. The sclerosing agent, 5% solution of ethanolamine oleate with iopamidol (EOI), was continuously infused into DV under the ballon infration until DV were filled with screlosant completely. No major procedure-related complications occurred. Post-BRTO endoscopy and abdominal CT showed successful obliteration of DV. In conclusion, we report a case of DV successfully treated with BRTO. There is no established treatment of DV. Further studies are needed to clarify appropriate treatment for the eradication of DV.