دورية أكاديمية
A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction
| العنوان: | A case of esophagojejunal varices rupture after proximal gastrectomy with double-tract reconstruction |
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| المؤلفون: | Naoki Shinno, Ryohei Kawabata, Haruna Furukawa, Seiichi Goda, Toshinori Sueda, Tae Matsumura, Chikato Koga, Shingo Noura, Junzo Shimizu, Atsuya Okada, Junichi Hasegawa |
| المصدر: | Surgical Case Reports, Vol 6, Iss 1, Pp 1-5 (2020) |
| بيانات النشر: | SpringerOpen, 2020. |
| سنة النشر: | 2020 |
| المجموعة: | LCC:Surgery |
| مصطلحات موضوعية: | PTO, Esophagojejunal varices, Proximal gastrectomy, Surgery, RD1-811 |
| الوصف: | Abstract Background The varices after proximal or total gastrectomy are uncommon because the supplying vessels are all divided. Emergent upper gastrointestinal endoscopy is the cornerstone of first-line management for the diagnosis and treatment of esophageal varices. However, there is no widely accepted standard strategy for esophagojejunal varices. We report a patient with esophagojejunal varices rupture 3 months after proximal gastrectomy treated with percutaneous transhepatic obliteration. Case presentation A 50-year-old man who had undergone proximal gastrectomy with double-tract reconstruction for esophagogastric junctional cancer 3 months before was admitted to the hospital due to gastrointestinal perforation. We performed emergency surgery and abdominal symptoms and inflammatory response improved postoperative. However, on POD3, he had eruptive bleeding at the just anal side of esophagojejunal anastomosis. Endoscopic clipping was unsuccessful because the mucosa was fragile and easily lacerated. Contrast-enhanced CT scan revealed the dilatation of the jejunal vein flowing into the ascending jejunal limb. Therefore, he was diagnosed as esophagojejunal varices rupture and percutaneous transhepatic obliteration (PTO) was tried for hemostasis. The portal and superior mesenteric veins were catheterized with the percutaneous transhepatic approach. Contrast agent injection into the jejunal branch demonstrated retrograde flow to the azygos vein through esophagojejunal varices. The microcatheter was inserted into the variceal blood supply branch and 10 mL of 5% ethanolamine oleate with iopamidol was injected. After obliteration therapy, the superior mesenteric venogram showed complete occlusion of the variceal supply branch. The patient was discharged from the hospital without any complications after 14 days. Conclusion PTO can be effective for gastroesophageal varices rupture with a dilated jejunal vein of the ascending limb, few supplying vessels, and little ascites. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2198-7793 93476973 |
| Relation: | https://doaj.org/toc/2198-7793 |
| DOI: | 10.1186/s40792-020-0775-6 |
| URL الوصول: | https://doaj.org/article/d9347697378d4100895cf49375167326 |
| رقم الأكسشن: | edsdoj.9347697378d4100895cf49375167326 |
| قاعدة البيانات: | Directory of Open Access Journals |
Find this article in full text from Springer Verlag. 
Full Text Finder | تدمد: | 21987793 93476973 |
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| DOI: | 10.1186/s40792-020-0775-6 |