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경정맥 간내문맥 - 간정맥 단락술로 십이지장정맥류 대량 출혈을 성공적으로 치료한 1 예
윤영준(Young Joon Yoon),한광협(Kwang Hyub Hahn),이도연(So Yun Lee),백용한(Yong Han Paik),정재연(Jae Yeon Chung),김철(Chul Kim),전재윤(Chae Yoon Chon),문영명(Young Myoung Moon) 대한소화기학회 2001 대한소화기학회지 Vol.38 No.4
Duodenal varices can be resulted from either liver cirrhosis or extrahepatic portal hypertension. Bleeding from duodenal varices is rare but often severe and life threatening. Bleeding of duodenal varices can be treated with non-surgical or surgical treatment. Non-surgical treatments include endoscopic variceal ligation, endoscopic sclerotherapy, and transjugular intrahepatic portosystemic shunt (TIPS). Surgical treatments include shunt surgery, variceal ligation, variceal resection, and duodenectomy. However, endoscopic treatments are not so effective and surgical interventions have many limitations. A 68-year-old man with liver cirrhosis was admitted to our department and presented with mental change and melena. He received a large amount of transfusion and it was not possible to perform gastrointestinal endoscopy. Emergency angiography revealed marked dilatation of mesenteric veins, which was treated by TIPS. After TIPS, transfusion requirement was markedly reduced and gastrointestinal endoscopy demonstrated duodenal varices without bleeding. We conclude that TIPS may be an effective therapeutic option for control of hemorrhage from duodenal varices. (Korean J Gastroenterol 2001;38:292-295)
조직접착제를 이용한 내시경적 정맥류 폐쇄요법으로 치유된 십이지장 정맥류 대량 출혈 2예
기영화 ( Young Hwa Ki ),김석현 ( Suk Hyun Kim ),송춘영 ( Chun Young Song ),이승우 ( Seung Woo Lee ),김연수 ( Yeon Soo Kim ),강상범 ( Sang Bum Kang ),남순우 ( Soon Woo Nam ) 대한내과학회 2008 대한내과학회지 Vol.75 No.2
십이지장 정맥류 출혈은 드물게 발생하며 대부분 진단이 어렵고 대량 출혈을 보여 치명적일 수 있다. 현재 식도와 위 정맥류 출혈과는 달리 효율적인 치료 방법이 명확하게 규정되어 있지 않다. 정맥류 출혈에서 내시경을 이용한 치료는 보다 비침습적이며, 초기에 단독으로 사용할 수 있으나, 십이지장 정맥류 출혈에서는 여러 제한점을 가지고 있으며 드물게 보고되고 있다. 십이지장 정맥류 출혈에서 내시경적 정맥류 폐쇄요법을 사용하여 재출혈 없이 성공적으로 지혈한 두 증례를 경험하였기에 보고하는 바이다. 향후 문맥고혈압 환자에서 십이지장 정맥류 출혈이 있을 경우 내시경적 정맥류 폐쇄요법은 초치료로서 사용될 수 있으며 예후를 향상시킬 수 있을 것으로 기대된다. Duodenal variceal bleeding is rare and difficult to diagnose. The rupture of duodenal varices leads to massive and often fatal bleeding. However, there is currently no definitive conservative therapy for duodenal varices, such as the methods used for treating esophageal and gastric varices. Endoscopic treatment of variceal hemorrhage has been implemented as an initial single, minimally invasive method for treatment. However, this approach has limited success in the treatment of duodenal variceal hemorrhage. We report two cases of massive duodenal variceal bleeding successfully controlled with endoscopic injection sclerotherapy. (Korean J Med 75:210-214, 2008)
A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration
Ji Hyun Lee,Tae Hwan Kim,Jong Won Choi,Sun Young Kim,Jin Young Choi,Chun Kyon Lee,Byung Kyu Park,Jae Bok Chung 소화기인터벤션의학회 2019 Gastrointestinal Intervention Vol.8 No.4
Duodenal varices are ectopic in nature and account for 40% of all ectopic bleeding cases. Ectopic variceal bleeding is rare (1%–5% of all variceal bleeding cases). The three principle approaches used to treat duodenal varices are endoscopic procedures, interventional radiological methods, and surgical interventions. A 59-year-old male with alcoholic liver cirrhosis and chronic hepatitis B infection visited our gastroenterology department with melena. Gastroduodenoscopy and computed tomography identified varices in the second part of the duodenum. We performed percutaneous transhepatic obliteration using glue and coil embolization, which obliterated the varices and resulted in immediate hemostasis. However, 3 months later, he re-visited presenting with newly developed duodenal varices and underwent endoscopic injection sclerotherapy.
A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration
Ji Hyun Lee,Tae Hwan Kim,Jong Won Choi,Sun Young Kim,Jin Young Choi,Chun Kyon Lee,Byung Kyu Park,Jae Bok Chung 소화기인터벤션의학회 2019 International journal of gastrointestinal interven Vol.8 No.4
Duodenal varices are ectopic in nature and account for 40% of all ectopic bleeding cases. Ectopic variceal bleeding is rare (1%–5% of all variceal bleeding cases). The three principle approaches used to treat duodenal varices are endoscopic procedures, interventional radiological methods, and surgical interventions. A 59-year-old male with alcoholic liver cirrhosis and chronic hepatitis B infection visited our gastroenterology department with melena. Gastroduodenoscopy and computed tomography identified varices in the second part of the duodenum. We performed percutaneous transhepatic obliteration using glue and coil embolization, which obliterated the varices and resulted in immediate hemostasis. However, 3 months later, he re-visited presenting with newly developed duodenal varices and underwent endoscopic injection sclerotherapy.
손병관 ( Byoung Kwan Son ),손주현 ( Joo Hyun Sohn ),장명희 ( Myung Hee Chang ),박윤경 ( Yoon Kyung Park ),김태엽 ( Tae Yeob Kim ),전용철 ( Yong Cheol Jeon ) 대한소화기학회 2007 대한소화기학회지 Vol.49 No.5
Duodenal varix is a rare cause of hemorrhage in patients with portal hypertension, however their rupture is serious and often life threatening. Treatments for duodenal variceal bleeding include endoscopic procedures, surgery, or interventional radiologic procedures. We report a case of duodenal varices rupture in a 45-year-old man with alcoholic liver cirrhosis who presented with melena and dizziness. Emergent upper endoscopy revealed large nodular varices with a ruptured erosion on the top in the distal second portion of duodenum. Two consecutive injections with 1.0 mL of n-butyl-2-cyanoacrylate (Histoacryl; Braun-Melsungen, Germany) mixed with 1.0 mL of lipiodol (Laboratoire-Guerbet, France) were performed intravariceally and achieved successful hemostasis. This suggests that endoscopic injection sclerotherapy with histoacryl may be an effective therapeutic option for the control of ruptured duodenal variceal bleeding. (Korean J Gastroenterol 2007;49:336-340)
PE-100: Pyelphlebitis Following Cyanoacrylate Injection into Duodenal Varix : A Rare Adverse Event
( Eunae Cho ),( Chung Hwan Jun ),( Kyu Man Cho ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1
We report a case of pyelphlebitis after duodenal varix obliteration using cyanoacrylate injection. A 55-year-old male presented with melena. Esophagogastroscopy revealed large duodenal varices with stigmata of recent bleeding and cyanoacrylate was injected. He was discharged from the hospital without further bleeding sign. Four months later, he developed fever and abdominal pain. Abdominal computed tomography and esophagogastroscopy showed disappearance of the duodenal varices but development of cholangitis and pyelphlebitis of the portal vein and superior mesenteric vein. The etiology of pyelphlebitis and treatment of duodenal varices are discussed.
( Ha Yan Kang ),( Won Kyung Lee ),( Yong Hyun Kim ),( Byung Woon Kwon ),( Myung Soo Kang ),( Suk Bae Kim ),( Ii Han Song ) 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2
Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.
강하얀,이원경,김용현,권병운,강명수,김석배,송일한 대한간학회 2011 Clinical and Molecular Hepatology(대한간학회지) Vol.17 No.2
Duodenal varices result from retroperitoneal portosystemic shunts that usually come from the pancreaticoduodenal vein and drain into the inferior vena cava. Because they are a rare but fatal cause of gastrointestinal bleeding, a prompt hemostatic intervention is mandatory. A 62-year-old man who had a history of excessive alcohol consumption presented with massive hematemesis and melena. Emergent endoscopy revealed ruptured varices with an adhering whitish fibrin clot on the postbulbar portion of the duodenum. Abdominal computed tomography demonstrated a cirrhotic liver with venous collaterals around the duodenum and extravasated contrast in the second and third portions. The collaterals originated from the main portal vein and drained via the right renal vein into the inferior vena cava. Endoscopic injection sclerotherapy with cyanoacrylate was successful in achieving hemostasis, and resulted in the near eradication of duodenal varices at a 6-month follow-up.