• Bleeding ectopic varices
• Enteroscopic injection sclerotherapy
• Portal hypertension
• Suspected small bowel bleeding
• Transjugular intrahepatic portosystemic shunt

• BRTO
• Cirrhosis
• Ectopic varices
• Intestinal bleeding
• Mesenteric superior veins
• Ovarian vein

• diagnosis
• double balloon enteroscopy
• ectopic varices
• endotherapy
• small bowel

• alcoholic liver diseases
• bleeding varices
• portal hypertension
• stoma
• varices

• gastric varices
• portal-hypertensive hemorrhage
• portosystemic shunt
• secondary prophylaxis
• variceal embolization

• This work was supported by: FIS 23/00997 & PI23/01102 funded by "Instituto de Salud Carlos III" and co-funded by the European Union. From "CIBEREHD" funded by "Instituto de Salud Carlos III". From the "Commissioner for Universities and Research from the This work was supported by: FIS 23/00997 & PI23/01102 funded by "Instituto de Salud Carlos III" and co-funded by the European Union. From "CIBEREHD" funded by "Instituto de Salud Carlos III". From the "Commissioner for Universities and Research from the

• ectopic varices
• endoscopy
• gastrointestinal bleeding
• histoacryl injection
• liver cirrhosis
• portal hypertension

• Case report
• Ectopic variceal bleeding
• Systematic review
• Transjugular intrahepatic portosystemic shunt
• Varices

• Humans
• Portasystemic Shunt, Transjugular Intrahepatic
• Gastrointestinal Hemorrhage/surgery
• Gastrointestinal Hemorrhage/etiology
• Esophageal and Gastric Varices/surgery
• Esophageal and Gastric Varices/complications
• Hypertension, Portal/complications
• Hypertension, Portal/surgery
• Female

• Humans
• Hypertension, Portal/complications
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Varicose Veins/complications
• Varicose Veins/therapy
• Portal Vein

• 32170788 National Natural Science Foundation of China
• 7232123 Beijing Natural Science Foundation
• 2022-PUMCH-A-020 National High-Level Hospital Clinical Research Funding
• ZK108000 National Key Clinical Specialty Construction

• artificial organs
• complication
• diagnostic
• imaging
• pancreas
• support devices
• techniques

• Humans
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Embolization, Therapeutic
• Varicose Veins/complications
• Varicose Veins/therapy
• Pancreas Transplantation/adverse effects

• Embolization
• Gastrointestinal hemorrhage
• Therapeutic

• Humans
• Gastrointestinal Hemorrhage/diagnosis
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Esophageal and Gastric Varices/complications
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/therapy
• Embolization, Therapeutic/methods
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Varicose Veins/complications
• Treatment Outcome

• Ectopic varices
• Embolization
• Omental varices
• TIPS

• cirrhosis
• colonic varices
• ectopic varices
• exploratory laparotomy
• portal hypertension

• ectopic varices
• endoscopy
• liver cirrhosis
• portal hypertension

Splenic vein thrombosis is a known complication of pancreatitis. It can lead to increased blood flow through mesenteric collaterals. This segmental hypertension may result in the development of colonic varices (CV) with a high risk of severe gastrointestinal bleeding. While clear guidelines for treatment are lacking, splenectomy or splenic artery embolization are often used to treat bleeding. Splenic vein stenting has been shown to be a safe option.

A 45-year-old female patient was admitted due to recurrent gastrointestinal bleeding. She was anemic with a hemoglobin of 8.0 g/dL. As a source of bleeding, CV were identified. Computed tomography scans revealed thrombotic occlusion of the splenic vein, presumably as a result of a severe acute pancreatitis 8 years prior. In a selective angiography, a dilated mesenterial collateral leading from the spleen to enlarged vessels in the right colonic flexure and draining into the superior mesenteric vein could be confirmed. The hepatic venous pressure gradient was within normal range. In an interdisciplinary board, transhepatic recanalization of the splenic vein via balloon dilatation and consecutive stenting, as well as coiling of the aberrant veins was discussed and successfully performed. Consecutive evaluation revealed complete regression of CV and splenomegaly as well as normalization of the red blood cell count during follow-up.

Recanalization and stenting of splenic vein thrombosis might be considered in patients with gastrointestinal bleeding due to CV. However, a multidisciplinary approach with a thorough workup and discussion of individualized therapeutic strategies is crucial in these difficult to treat patients.

• Pancreatitis-induced splenic vein thrombosis
• Gastrointestinal hemorrhage
• Colonic varices
• Splenic vein stenting
• Segmental/sinistral hypertension
• Case report

• Female
• Humans
• Middle Aged
• Acute Disease
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Pancreatitis/complications
• Portal Vein/diagnostic imaging
• Splenic Diseases
• Splenic Vein/diagnostic imaging
• Varicose Veins/complications
• Venous Thrombosis/diagnostic imaging
• Venous Thrombosis/etiology
• Venous Thrombosis/therapy
• Tomography, X-Ray Computed

• Rectal varices
• embolisation
• varices coiling

• TIPS
• angiography
• paracentesis
• portal hypertension
• variceal bleed

• Portal vein
• islet cell transplantation
• portal vein embolization
• portal vein recanalization
• thrombolysis
• transjugular intrahepatic portosystemic shunt

Gastrointestinal bleeding accounts for a drastic negative impact on the quality of the patients’ lives as it requires multiple diagnostic and therapeutic interventions to identify the source of the bleeding. Small bowel bleeding is the least common cause of gastrointestinal bleeding. However, it is responsible for the majority of complaints from patients with persisting or recurring bleeding where the primary source of bleeding cannot be identified despite investigation. A somatostatin analog known as octreotide is among the medical treatment modalities currently used to manage small bowel bleeding. This medication helps control symptoms of gastrointestinal bleeding by augmenting platelet aggregation, decreasing splanchnic blood flow, and antagonizing angiogenesis. In this review article, we will highlight the clinical efficacy of octreotide in small bowel bleeding and its subsequent effect on morbidity and mortality.

• Octreotide
• Small bowel
• Hemorrhage
• Angiodysplasia
• Vascular malformations
• Hereditary hemorrhagic telangiectasia

• endoscopy
• hypertension
• liver
• liver cirrhosis
• portal

• End Stage Liver Disease/complications
• Esophageal and Gastric Varices/complications
• Fibrosis
• Gastrointestinal Hemorrhage/complications
• Humans
• Liver Cirrhosis/complications
• Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
• Retrospective Studies
• Severity of Illness Index
• Treatment Outcome
• Varicose Veins/complications

• P20 GM130457 NIGMS NIH HHS
• UL1 TR001450 NCATS NIH HHS

• constriction, pathologic
• gastrointestinal hemorrhage
• kidney transplantation
• pancreas transplantation
• varicose veins

An 11-year-old boy with a history of hepatoblastoma treated with chemotherapy, radiation therapy, and liver transplantation presented with bleeding from Roux-en-Y limb varices. The transhepatic approach for portal intervention posed a risk of liver graft injury. An omental vein that was dilated as a collateral vein due to portal hypertension was found and compressible under ultrasound. The omental vein was percutaneously punctured, and the varices were embolized through a jejunal vein. No complication occurred. Direct percutaneous access to the portal venous system is a useful technique for portal embolization.

We report a case of a 53-year-old male with decompensated liver cirrhosis secondary to alcohol abuse and hepatitis C infection who was admitted for hemorrhagic shock secondary to upper GI bleed. He underwent a therapeutic paracentesis 17 days after admission with the removal of 6 L of ascitic fluid. The patient became hemodynamically unstable after paracentesis and an acute drop in his hemoglobin was noted. On imaging, he was found to have massive hemoperitoneum secondary to a bleeding mesenteric varix. This is a very rare complication of paracentesis in patients with advanced cirrhosis and should be recognized early in the post-procedure period to initiate prompt life-saving measures to minimize morbidity and mortality.

• alcoholic cirrhosis
• ectopic varices
• extrahepatic portal hypertension
• intraperitoneal bleeding
• ir guided embolization

Bleeding from ileal varices is a rare and a life-threatening situation. Its management is difficult and includes endoscopic, surgical and interventional radiology treatment.

Here we report a successful emergency surgery for bleeding ileal varices in a patient with cirrhosis due to autoimmune hepatitis.

A 60-year-old woman was admitted for rectal bleeding. She had a history of autoimmune hepatitis. She was treated by endoscopic ligation for oesophageal varices.

Eso-gastro-duodenal fibroscopy and colonoscopy failed to reveal the bleeding site.

CT scan was then performed showing ileal varices due to a portocaval shunt, there was a communication between the superior mesenteric vein and the right internal iliac vein.

As the embolization was not feasible and the bleeding did not stop, an exploratory laparotomy was performed showing two dilated veins on the surface of the ileal wall, communicating with the right internal iliac vein. We performed a ligation of the vessels. Postoperative course was uneventful.

Ectopic varices are a rare case of gastrointestinal bleeding. Most of those patients have portal hypertension and liver cirrhosis.

Diagnosing bleeding ileal varices is difficult because endoscopic examination can't always reveal the bleeding site.

Interventional radiology is a good option for patients having bleeding ileal varices knowing that they often have advanced liver cirrhosis making them poor candidates for surgery.

Haemostasis by endoscopy is often temporary and bleeding frequently recurs.

Surgery should be considered if non-invasive treatments failed to ensure the haemostasis.

Bleeding ileal varices is a rare situation. Interventional radiology and endoscopy can be good options. If not feasible, surgical treatment should not be delayed.

•

Ectopic varices are a rare case of gastrointestinal bleeding.

• Gastrointestinal bleeding
• Ileal varices
• Portal hypertension

Among the various causes for lower gastrointestinal bleeding, ectopic varices constitute a small chunk. Though rare, these can pose a diagnostic challenge with recurrent bleed leading to multiple admission and blood transfusions.

A 41-year-old male presented to our department with multiple episodes of melena. On further evaluation with CT angiography, a diagnosis of extrahepatic portal vein obstruction with moderate splenomegaly and ectopic jejunal varix was made. He underwent splenectomy with resection of involved jejunal segment with side to side anastomosis.

The diagnosis of ectopic varices remains elusive in a large number of cases in view of the varied etiology. Various newer endoscopic and imaging modalities can play a diagnostic as well as therapeutic role but this also further complicates the management as there is a lack of substantial guidelines directing the treatment protocol. As a result, we have to resort to a case by case approach for the optimal management in these cases.

The main modality of management for bleeding ectopic varices is percutaneous or endoscopic. Surgery is reserved for refractory cases, with decompressive shunts combined with segmental resection of involved intestine being at the forefront of surgical options.

•

Ectopic varices are an unusual cause of lower GI bleeding caused by porto-systemic collaterals.

• Decompressive surgery
• EHPVO
• Ectopic varices
• Splenectomy

Portosystemic collateralization is usually seen in patients with portal hypertension. Bleeding from the ectopic varices is reportedly rare. We present a case of a 55-year-old gentleman who presented with complaints of bleeding from the umbilicus. On examination, he was tachycardic, hypotensive, and in hypovolemic shock. Bleeding was suspected to be from the umbilical varices. Contrast-enhanced computed tomography of the abdomen with abdominal angiography revealed a cirrhotic liver with partial thrombosis of the portal vein with collaterals in the perigastric, lower esophageal, peripancreatic, splenic and mesenteric, umbilical and paraumbilical collaterals with recanalization of the umbilical vein. The bleeder was identified to be the collateral at the umbilical region from the superior mesenteric vein. The patient was treated with a Doppler-guided injection of a sclerosant into the collateral, thereby achieving successful hemostasis.

• omphalic bleed
• sclerosant injection
• surgical emergency scenarios
• suture ligation
• umbilical varices

• Adult
• Disease Management
• Duodenal Diseases/complications
• Duodenal Diseases/diagnostic imaging
• Duodenal Diseases/surgery
• Endoscopy, Gastrointestinal/methods
• Gastrointestinal Hemorrhage/complications
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/surgery
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/surgery
• Male

Hematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors, prostate hyperplasia, and urinary stone disease. Hematuria due to vesical varices is very rare, and only a few cases have been reported since 1989. We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.

This patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis. He was admitted to the emergency department with severe hematuria and bladder clot tamponade. Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound, contrast-enhanced computed tomography, and three-dimensional visualization technology. It was difficult to perform transurethral cystoscopy and hemostasis in this patient, so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.

Urologists should improve the understanding of the pathophysiology, clinical manifestations, diagnosis, and treatment of vesical varices. This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.

• Vesical varices
• Portal hypertension
• Three-dimensional visualization technology
• Case report

Extrahepatic portal vein obstruction (EHPVO) with portal hypertension is rare in children. Intestinal varices as new collaterals accompanying portal hypertension are very rare.

We report an unusual case of a 12-year-old boy with EHPVO with gastrointestinal bleeding from ectopic jejunal varices, without any gastroesophageal varices.

Portal hypertension is the most common cause of EHPVO. Among various ectopic varices, intestinal varices are found distal to the duodenum and present with complaints of hematochezia, melena, or intraperitoneal bleeding. The diagnosis of the EHPVO is aided by imaging investigations like Doppler ultrasound, computed tomography, or magnetic resonance imaging. A multidisciplinary team including gastroenterologists, interventional radiologists, surgeons, and intensivists is crucial in the management of ectopic varices.

Jejunal varices must be considered in the differential diagnosis of gastrointestinal (GI) hemorrhage in patients with a negative source of bleed on upper and lower GI endoscopy.

•

Intestinal varices are rarely developed as new collaterals accompanying portal hypertension with EHPVO (Extrahepatic portal vein obstruction).

• Gastrointestinal hemorrhage
• Jejunal varices
• Portal hypertension

• duodenal varices
• endoscopic treatment
• portal hypertension

• Adult
• Aged
• Esophageal and Gastric Varices
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/therapy
• Humans
• Hypertension, Portal
• Male
• Middle Aged
• Sclerotherapy/adverse effects
• Varicose Veins

• Colopathy
• enteropathy
• gastropathy
• mucosa
• portal hypertension
• vasculopathy.

• Clinical characteristics
• ectopic varices
• endoscopic treatment

More than five decades after it was originally conceptualized as rescue therapy for patients with intractable variceal bleeding, the transjugular intrahepatic portosystemic shunt (TIPS) procedure continues to remain a focus of intense clinical and biomedical research. By the impressive reduction in portal pressure achieved by this intervention, coupled with its minimally invasive nature, TIPS has gained increasing acceptance in the treatment of complications of portal hypertension. The early years of TIPS were plagued by poor long-term patency of the stents and increased incidence of hepatic encephalopathy. Moreover, the diversion of portal flow after placement of TIPS often resulted in derangement of hepatic functions, which was occasionally severe. While the incidence of shunt dysfunction has markedly reduced with the advent of covered stents, hepatic encephalopathy and instances of early liver failure continue to remain a significant issue after TIPS. It has emerged over the years that careful selection of patients and diligent post-procedural care is of paramount importance to optimize the outcome after TIPS. The past twenty years have seen multiple studies redefining the role of TIPS in the management of variceal bleeding and refractory ascites while exploring its application in other complications of cirrhosis like hepatic hydrothorax, portal hypertensive gastropathy, ectopic varices, hepatorenal and hepatopulmonary syndromes, non-tumoral portal vein thrombosis and chylous ascites. It has also been utilized to good effect before extrahepatic abdominal surgery to reduce perioperative morbidity and mortality. The current article aims to review the updated literature on the status of TIPS in the management of patients with liver cirrhosis.

• Early transjugular portosystemic shunt
• Preemptive transjugular intrahepatic portosystemic shunt
• Portal hypertension
• Esophageal varices
• Gastric varices
• Refractory ascites

• Ascites
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/surgery
• Gastrointestinal Hemorrhage/etiology
• Gastrointestinal Hemorrhage/surgery
• Humans
• Liver Cirrhosis/complications
• Liver Cirrhosis/surgery
• Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
• Treatment Outcome

• HCV-related liver cirrhosis
• autopsy
• caput medusae
• ectopic variceal hemorrhage
• forensic pathology
• portal hypertension

• Colonic varices
• Ectopic varices
• Pancreatic cancer
• Transileocolic vein obliteration (TIO)

Patient: Male, 51-year-old

Final Diagnosis: Ectopic varix

Symptoms: Bleeding • portal hypertension

Medication:—

Clinical Procedure: —

Specialty: Transplantology

Severe portal hypertension is life-threatening and can bring adverse complications such as ascites, gastroesophageal varices, and edema. It can, even cause variceal hemorrhage, which may lead to a high risk of death. There is a rare incidence in bleeding of hemorrhoids caused by severe ectopic varices.

We report the case of a female patient with a 20-year history of hepatitis B virus infection who presented with repeated bleeding of hemorrhoids caused by severe portal hypertension with ectopic varices that is connection between the superior mesenteric vein and rectal venous plexus. Laboratory results revealed a hemoglobin level of 74 g/L. Finally, the patient was successfully treated with transjugular intrahepatic portosystemic shunt (TIPSS) placement without variceal embolization after a multidisciplinary comprehensive opinion. In the two-month follow-up period, the patient had failed to develop hepatic encephalopathy or hematochezia, and computed tomography venography (CTV) indicated that the stent was unobstructed and ascites disappeared.

TIPSS placement is effective for the case, and we hope this case can help improve clinicians’ awareness of hemorrhoidal bleeding with severe portal hypertension. Portal hypertension should also be considered during the diagnosis and treatment, as opposed to hemorrhoidal bleeding alone. Moreover, abdominal CTV is recommended as an effective imaging examination method to determine the stent status after operation.

• Ectopic varices
• Hemorrhoidal bleeding
• Portal hypertension
• Transjugular intrahepatic portosystemic shunt

Lower gastrointestinal bleeding (LGIB) is a serious and potentially life-threatening condition warranting hospital admission. The most frequent causes include diverticular disease, colitis, hemorrhoids, neoplasm, inflammatory bowel disease, and varices. Varices usually occur secondary to liver cirrhosis and are frequently located in the gastroesophageal region. Those occurring elsewhere are known as ectopic varices. The diagnosis and management of ectopic varices is challenging, and guidelines are not currently available. We report the case of recurrent large-volume hematochezia secondary to a cecal varix in a 60-year-old female with alcoholic liver cirrhosis. Initial investigation with CT angiography and endoscopy failed to identify the source of bleeding. A second CT angiogram identified a large varix in the cecum, and the patient was successfully managed with radiological embolization and transjugular intra-hepatic porto-systemic shunt (TIPSS). 

• cecal varix
• ectopic varices
• embolisation
• hematochezia
• tippss
• variceal bleed

Ectopic varices account for 1%–5% of all variceal bleeding episodes. The most common presentation of cecal varices is an acute episode of a massive lower gastrointestinal hemorrhage. However, cecal varices can be found incidentally and can be silent for a prolonged period of time before presenting with a massive gastrointestinal hemorrhage. Through this case of a 63-year-old woman, we would like to highlight the paucity of literature in the treatment of nonbleeding cecal varices.