A Case of Bleeding Duodenal Varices Located at the Blind End of the Afferent Duodenal Loop Created by the Billroth-II Technic in which Hemostasis Could Successfully be Attained by the Use of Histoacryl

Abstract

The patient in this case was an 81-year-old man with a history of gastrectomy performed at his age of 69. While receiving ambulatory therapy for alcoholic cirrhosis of the liver, obsolete myocardial infarction, chronic heart failure and chronic renal failure he was hospitalized due to melena. On emergency endoscopy there were noted multiple shallow gastric ulcers on the oral side of the gastrojejunostomy, although no esophageal nor gastric varices were detected. Treatment was begun with local injection of ethoxysclerol.
However, as the passage of bloody stools persisted still on the following day, an in-depth exploratory endoscopic examination resulted in identification of nodular varices located on the opposite side of the Vater's papilla at the blind end of the afferent duodenal loop as the source of bleeding. Because of fibrin plugs noticed at the vertexes of the varices an attempt was made to administer Histoacryl by local injection, which proved successful in arresting bleeding.
The present case was considered worth reporting in that local injection of Histoacryl proved to be effective in stopping bleeding from duodenal varices that developed at the closed stump of the afferent duodenojejunal loop created by the Billroth-II technic.