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Moya Abuhadba R, Steffens Venegas E, Iglesias Bettini A, Roa JC, Besa C, Espino A, Larach JT. Gastrointestinal bleeding due to vascular malformation secondary to mesenteric-gonadal portosystemic shunt in pre-transplant chronic liver disease. ANZ J Surg 2023; 93:3003-3005. [PMID: 37607100 DOI: 10.1111/ans.18665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023]
Affiliation(s)
| | | | | | - Juan Carlos Roa
- Department of Pathological Anatomy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cecilia Besa
- Department of Radiology, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Radiology, Millenium Institute for Intelligent Healthcare Engineering, ANID, Chile
| | - Alberto Espino
- Department of Endoscopy, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Tomas Larach
- Department of Digestive Surgery, Pontificia Universidad Católica de Chile, Santiago, Chile
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Gheorghiu AC, Proserpio M, Regusci L, Pagnamenta A. Ectopic varices masquerading as lower gastrointestinal bleeding. BMJ Case Rep 2019; 12:12/1/e227469. [PMID: 30709832 DOI: 10.1136/bcr-2018-227469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A middle-aged woman previously in good health arrived to hospital with severe haemorrhagic shock. An abdominal and pelvic CT scan showed hepatomegaly, fluid in the sigmoid colon, perigastric and right sided pelvic varices without a clear source of bleeding. Urgent esophagogastroduodenoscopy excluded gastric varices and active upper gastrointestinal bleeding and the colonoscopy was inconclusive due to haemodynamic instability and massive bleeding which made it impossible to proceed with a full colonoscopy. An explorative laparotomy identified liver cirrhosis and bleeding from varices of the right fallopian tube which had formed a fistula with the caecum. A right hemicolectomy with a side to side anastomosis and a right sided salpingo-oophorectomy were carried out. The patient was thereafter transferred to the intensive care unit intubated, requiring massive fluid resuscitation and high doses of vasoactive agents. Nine days after hospital admission she was transferred to the surgical ward and followed up by a hepatologist.
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Affiliation(s)
- Alina Cristiana Gheorghiu
- Intensive Care Medicine, Ente Ospedaliero Cantonale, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
| | - Michele Proserpio
- Intensive Care Medicine, Ente Ospedaliero Cantonale, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
| | - Luca Regusci
- Department of Surgery, Ente Ospedaliero Cantonale, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
| | - Alberto Pagnamenta
- Intensive Care Medicine, Ente Ospedaliero Cantonale, Ospedale Regionale di Mendrisio, Mendrisio, Switzerland
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Minowa K, Komatsu S, Takashina K, Tanaka S, Kumano T, Imura K, Shimomura K, Ikeda J, Taniguchi F, Ueshima Y, Lee T, Ikeda E, Otsuji E, Shioaki Y. Ectopic gastrointestinal variceal bleeding with portal hypertension. World J Gastrointest Surg 2017; 9:288-292. [PMID: 29359035 PMCID: PMC5752964 DOI: 10.4240/wjgs.v9.i12.288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/07/2017] [Accepted: 11/12/2017] [Indexed: 02/07/2023] Open
Abstract
Massive gastrointestinal bleeding from gastrointestinal varices is one of the most serious complications in patients with portal hypertension. However, if no bleeding point can be detected by endoscopy in the predilection sites of gastrointestinal varices, such as the esophagus and stomach, ectopic gastrointestinal variceal bleeding should be considered as a differential diagnosis. Herein, we report a case of ectopic ileal variceal bleeding in a 57-year-old woman, which was successfully diagnosed by multi-detector row CT (MDCT) and angiography and treated by segmental ileum resection. To date, there have been no consensus for the treatment of ectopic ileal variceal bleeding. This review was designed to clarify the clinical characteristics of patients with ectopic ileal variceal and discuss possible treatment strategies. From the PubMed database and our own database, we reviewed 21 consecutive cases of ileal variceal bleeding diagnosed from 1982 to 2017. MDCT and angiography is useful for the rapid examination and surgical resection of an affected lesion and is a safe and effective treatment strategy to avoid further bleeding.
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Affiliation(s)
- Keita Minowa
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
- Emergency and Critical Care Center, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Shuhei Komatsu
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Kenichiro Takashina
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
- Emergency and Critical Care Center, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Sachie Tanaka
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Tatsuya Kumano
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Kenichiro Imura
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Katsumi Shimomura
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Jun Ikeda
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Fumihiro Taniguchi
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Yasuo Ueshima
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Tecchuu Lee
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Eito Ikeda
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
| | - Eigo Otsuji
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Yasuhiro Shioaki
- Department of Surgery, Japanese Red Cross Kyoto Daiichi Hospital, Higashiyama-ku, Kyoto 605-0981, Japan
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