A Case of Extensive Upper Gastro Intestinal Injury after Balloon-occuladed Retrograde Transvenous Obliteration (B-RTO)

Abstract

A 81-year-old man with type C liver cirrhosis and hepatocellular carcinoma was admitted to our hospital for the treatment of gastric varices. On Nov. 29th. 2000, B-RTO was performed. From next day, ascites appeared and gradually increased.
He complained of epigastralgia. Melena was noticed. Upper gastrointestinal fiberscope revealed the presence of esophagitis, multiple gastric hemorrhagic erosions and multiple duodenal ulcers. Esophagitis and gastric erosions healed and duodenal ulcers improved to H1 stage by the treatment with proton pump inhibitor (PPI) for 10 days. After ascites also disappeared by use of diuretics, he discharged.
Since ascites increased in the beginning of January 2000, he was re-admitted to our hospital on January, 22th. Two days later, he had hematemesis and similar extensive lesions to previous examination were found. These lesions appeared following occurrence of ascites, suggesting that the elevation of portal venous pressure induced by B-RTO might play a causative role in gastro intestinal injuries of this patient.