Jejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage. Issue 3 (7th March 2019)

• Record Type: Journal Article
• Authors: Heiberger, Caleb Joseph; Mehta, Tej Ishaan; Yim, Douglas
• Is Part Of: BMJ case reports. Volume 12:Issue 3(2019)
• Publication Date: 2019-03-07
• Subjects: interventional radiology -- GI bleeding -- varices; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-228680
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : A 78-year-old woman presented with melaenic stool and severe anaemia 4 years after a pancreaticoduodenectomy for adenocarcinoma of the pancreas. Initial workup revealed haemorrhage from the choledochojejunostomy site. Despite multiple endoscopic clips to the region, bleeding reoccurred multiple times over a period of several months. Due to ongoing haemorrhage, her case was urgently presented at the hospital's multidisciplinary hepatobiliary conference. The contrast-enhanced abdominal CT revealed severe stenosis of the extrahepatic portal vein and large afferent jejunal varices at the choledochojejunostomy, suspected as the cause of her persistent bleed. The recommendation was a percutaneous transhepatic approach for stenting of the portal vein stenosis that resulted in rapid decompression of the jejunal varices and control of her haemorrhage.