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Chooklin S, Chuklin S, Chukla R. Ectopic varices: anatomical features for surgeons and interventional radiologists. EMERGENCY MEDICINE 2023; 19:299-311. [DOI: 10.22141/2224-0586.19.5.2023.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Ectopic varices are defined as dilated portosystemic collateral veins located in unusual sites, other than the gastroesophageal region. They develop secondary to portal hypertension, surgical procedures, anomalies in venous outflow, or abdominal vascular thrombosis and may be familial. Ectopic varices represent a clinical challenge because they are difficult to localize. Missing or misinterpreting these lesions can have serious consequences, and treatment options are unclear. Ectopic varices may be detected during panendoscopy, enteroscopy, endoscopic ultrasound, wireless capsule endoscopy, diagnostic angiography, multislice helical computed tomography, magnetic resonance angiography, color Doppler flow imaging, laparotomy, laparoscopy and occasionally during autopsy. They can be an important cause of bleeding and hepatic encephalopathy, so radiologists must effectively identify them to assist in making therapeutic decisions. Knowledge of the anatomy and course of these unusual portosystemic collaterals is also important for interventional radiologists and surgeons as it helps avoid inadvertent vascular damage during invasive procedures. In this article, we explore the parts of the gastrointestinal tract and organs that may be involved in ectopic varices. Literature search was conducted in the MedLine database on the PubMed platform.
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Desai G, Wagle PK. First jejunal vein, jejunal trunk, and pancreatico-duodenectomy: resolving the literature conundrum. Langenbecks Arch Surg 2023; 408:104. [PMID: 36826524 DOI: 10.1007/s00423-023-02849-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 02/18/2023] [Indexed: 02/25/2023]
Abstract
A detailed knowledge of the surgical anatomy of tributaries of the superior mesenteric vein, especially proximal jejunal venous anatomy (first jejunal vein and jejunal trunk), is a key prerequisite for performing a safe pancreatico-duodenectomy. However, the available literature on the anatomical course and surgical relevance of these vessels is scarce, the nomenclature across the articles is heterogeneous, and the resulting evidence is confusing to interpret. Standardized terminology and an in-depth review of these vessels with regard to their course, termination, vascular relations, and variations will help the surgeons in planning and performing this complex surgery safely, especially when a venous resection and reconstruction is planned in cases of borderline resectable pancreatic cancer. A uniform nomenclature and a unifying classification are proposed in this review for these two tributaries to help resolve the literature conundrum. This standardized terminology and anatomical description will assist the radiologists in reporting pancreatic protocol-computed tomography scans and surgeons in selecting the appropriate steps for the different anatomical orientations of these tributaries for the performance of safe pancreatic surgery. This will also help future researchers communicate in well-defined terms in reference to these tributaries so as to avoid confusion in future studies.
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Affiliation(s)
- Gunjan Desai
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, 400050, India.
| | - Prasad K Wagle
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Mumbai, 400050, India
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Barath S, Kheradia D, Gopalkrishnan SP, R. RK, K. MRP. Review of Applied Anatomy, Hemodynamics, and Endovascular Management of Ectopic Varices. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2021. [DOI: 10.1055/s-0041-1730868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
AbstractPortal hypertension leads to the opening up of collateral pathways to bypass the occlusion or resistance in the portal system. Ectopic varices are formed by such collaterals at many various sites along the gastrointestinal tract other than the usual location, that is, gastroesophageal region. Early diagnosis of ectopic varices needs strong clinical suspicion and contrast-enhanced computed tomography scan as endoscopy may often fail to pinpoint a source. In contrast to gastric varices where the understanding of the disease, as well as endovascular management, is widely studied and documented, the same is not true for ectopic varices due to low incidence. Understanding the applied anatomy and hemodynamic classification is important to decide the most suitable therapy. Interventional radiological procedures are aimed at either decompressing the varices or obliterating them and depend on the patency of the portal system, underlying etiology, and local expertise.
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Affiliation(s)
- Sitaram Barath
- Interventional Radiology Subdivision, Department of Radiology, Geetanjali Medical College & Hospital, Udaipur, Rajasthan, India
| | | | | | - Rahul K. R.
- Government Medical College, Kozhikode, Kerala, India
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A report of a case: unusual portosystemic shunt in a hernia sac who has portal hypertension due to cirrhosis. Surg Radiol Anat 2020; 43:385-388. [PMID: 32965518 DOI: 10.1007/s00276-020-02568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/04/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Variations in the origin and branching pattern of splenic vein (SV) are relatively rare and asymptomatic. We describe here only the first case in the literature of accessory SV in hernia sac due to previous operation and increased portal pressure because of cirrhosis. CASE PRESENTATION This report describes a 66-year-old female, with a history of total abdominal hysterectomy (TAH) due to uterine myomatosis, signs of cirrhosis onset due to hepatitis B, who had been presented with recurrent abdominal pain attacks. Ultrasonography (USG) findings were nothing pathologic except a gallstone in the gallbladder without cholecystitis signs. Incisional hernia was found to contain an accessory SV in the hernia sac arising from a branch of main SV in the hilum, ongoing to the subcutaneous fat tissue and draining to the superficial femoral vein on computed tomography (CT). Videoendoscopy showed wide gastritis and multiple ulcers. The patient's symptoms diminished with proton pump inhibitor (PPI) treatment and they then underwent a hernia repair surgery with Prolene mesh patch as elective surgery. CONCLUSIONS A thorough knowledge of the normal anatomy, most frequent variations and congenital or acquired anomalies of the spleno-portal axis has great importance for hepatopancreaticobiliary and emergency surgical procedures. It is, therefore, essential for preoperative evaluation of the anatomical details of the spleno-portal venous axis and should be evaluated with imaging methods in detail.
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Sharma M, Somani P, Rameshbabu CS, Sunkara T, Rai P. Stepwise evaluation of liver sectors and liver segments by endoscopic ultrasound. World J Gastrointest Endosc 2018; 10:326-339. [PMID: 30487943 PMCID: PMC6247100 DOI: 10.4253/wjge.v10.i11.326] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/16/2018] [Accepted: 10/17/2018] [Indexed: 02/06/2023] Open
Abstract
The liver has eight segments, which are referred to by numbers or by names. The numbering of the segments is done in a counterclockwise manner with the liver being viewed from the inferior surface, starting from Segment I (the caudate lobe). Standard anatomical description of the liver segments is available by computed tomographic scan and ultrasonography. Endoscopic ultrasound (EUS) has been used for a detailed imaging of many intra-abdominal organs and for the assessment of intra-abdominal vasculature. A stepwise evaluation of the liver segments by EUS has not been described. In this article, we have described a stepwise evaluation of the liver segments by EUS. This information can be useful for planning successful radical surgeries, preparing for biopsy, portal vein embolization, transjugular intrahepatic portosystemic shunt, tumour resection or partial hepatectomy, and for planning EUS guided diagnostic and therapeutic procedures.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
- Department of Gastroenterology, Thumbay Hospital, Dubai 415555, United Arab Emirates
| | | | - Tagore Sunkara
- Department of Gastroenterology and Hepatology, the Brooklyn Hospital Center, Clinical Affliate of The Mount Sinai Hospital, Brooklyn, NY 11201, United States
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow 226014, Uttar Pradesh, India
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Sharma M, Somani P, Rameshbabu CS. Linear endoscopic ultrasound evaluation of hepatic veins. World J Gastrointest Endosc 2018; 10:283-293. [PMID: 30364872 PMCID: PMC6198311 DOI: 10.4253/wjge.v10.i10.283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 08/03/2018] [Accepted: 08/13/2018] [Indexed: 02/06/2023] Open
Abstract
Liver resection surgery can be associated with significant perioperative mortality and morbidity. Extensive knowledge of the vascular anatomy is essential for successful, uncomplicated liver surgeries. Various imaging techniques like multidetector computed tomographic and magnetic resonance angiography are used to provide information about hepatic vasculature. Linear endoscopic ultrasound (EUS) can offer a detailed evaluation of hepatic veins, help in assessment of liver segments and can offer a possible route for EUS guided vascular endotherapy involving hepatic veins. A standard technique for visualization of hepatic veins by linear EUS has not been described. This review paper describes the normal EUS anatomy of hepatic veins and a standard technique for visualization of hepatic veins from four stations. With practice an imaging of all the hepatic veins is possible from four stations. The imaging from fundus of stomach is the easiest and most convenient method of imaging of hepatic veins. EUS of hepatic vein and the tributaries is an operator dependent technique and in expert hands may give a mapping comparable to computed tomographic and magnetic resonance imaging. EUS of hepatic veins can help in identification of individual sectors and segments of liver. EUS guided interventions involving hepatic veins may require approach from different stations.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
| | - Piyush Somani
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut 25001, Uttar Pradesh, India
- Department of Gastroenterology, Thumbay Hospital, Dubai 415555, United Arab Emirates
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7
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Affiliation(s)
- Amit Pathak
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Abid Shoukat
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - N S Thomas
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Divij Mehta
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Saket, Meerut, Uttar Pradesh, India
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Sharma M, Rai P, Rameshbabu CS, Arya S. Imaging of the pancreatic duct by linear endoscopic ultrasound. Endosc Ultrasound 2015; 4:198-207. [PMID: 26374577 PMCID: PMC4568631 DOI: 10.4103/2303-9027.162997] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 10/14/2014] [Indexed: 12/15/2022] Open
Abstract
The current gold standard investigation for anatomic exploration of the pancreatic duct (PD) is endoscopic retrograde cholangiopancreatography. Magnetic resonance cholangiopancreatography is a noninvasive method for exploration of the PD. A comprehensive evaluation of the course of PD and its branches has not been described by endoscopic ultrasound (EUS). In this article, we describe the techniques of imaging of PD using linear EUS.
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | | | - Shalini Arya
- Department of Medicine, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
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Sharma M, Rai P, Mehta V, Rameshbabu CS. Techniques of imaging of the aorta and its first order branches by endoscopic ultrasound (with videos). Endosc Ultrasound 2015; 4:98-108. [PMID: 26020043 PMCID: PMC4445183 DOI: 10.4103/2303-9027.156722] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 08/20/2014] [Indexed: 12/28/2022] Open
Abstract
Endoscopic ultrasonography (EUS) is a useful modality for imaging of the blood vessels of the mediastinum and abdomen. The aorta acts as an important home base during EUS imaging. The aorta and its branches are accessible by standard angiographic methods, but endosonography also provides a unique opportunity to evaluate the aorta and its branches. This article describes the techniques of imaging of different part of the aorta by EUS.
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Affiliation(s)
- Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, India
| | - Praveer Rai
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute (SGPGI), Lucknow, India
| | - Varun Mehta
- Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - C S Rameshbabu
- Department of Anatomy, Muzaffarnagar Medical College, Muzaffarnagar, Uttar Pradesh, India
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Lv PH, Zhang XC, Wang LF, Chen ZL, Shi HB. Management of isolated superior mesenteric artery dissection. World J Gastroenterol 2014; 20:17179-17184. [PMID: 25493033 PMCID: PMC4258589 DOI: 10.3748/wjg.v20.i45.17179] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/20/2014] [Accepted: 09/30/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate our experience of the clinical management of spontaneous isolated superior mesenteric artery dissection (ISMAD).
METHODS: From January 2008 to July 2013, 18 patients with ISMAD were retrospectively analyzed, including 7 patients who received conservative therapy, 9 patients who received reconstruction with bare stents, and 2 patients who underwent surgical treatment. The decision to intervene was based on anatomic suitability, patient comorbidities and symptoms.
RESULTS: Intestinal ischemia-related symptoms completely resolved in 7 patients who received conservative therapy. Stent placement was successful in 9 patients. Of the 9 patients who received endovascular stenting, abdominal pain was alleviated after the procedure and gradually disappeared within 3 d. Follow-up computed tomography and computed tomography angiography were available in all patients during the first month and the first year after the procedure, which revealed patent stent and patent involved superior mesenteric artery branches with complete obliteration of the dissection lesion. In the 2 patients who underwent surgical treatment, good clinical efficacy was also observed.
CONCLUSION: ISMAD may be managed successfully in a variety of ways based on the clinical symptoms. ISMAD should be treated by conservative management as the first-line option, however, in those with bowel necrosis or imminent arterial rupture during conservative therapy, endovascular or surgical therapy is indicated.
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Sharma M, Rai P, Rameshbabu CS. Techniques of imaging of nodal stations of gastric cancer by endoscopic ultrasound. Endosc Ultrasound 2014; 3:179-90. [PMID: 25184125 PMCID: PMC4145479 DOI: 10.4103/2303-9027.138793] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 04/06/2014] [Indexed: 12/12/2022] Open
Abstract
Nodal staging is of crucial importance in the management of gastric cancer (GC). The available modalities of nodal imaging in GC do not provide a high sensitivity and specificity of lymph node status. Comparative study of endoscopic ultrasonography (EUS) and multislice spiral computed tomography in GC has shown greater accuracy of EUS for N staging. EUS is not used routinely in patients with GC as it is not available at all centers, and its accuracy is operator dependent. Standard techniques of identification of nodal station (as suggested by Japanese Research Society for the Study of Gastric Cancer) by EUS have not been described so far. Identification of each nodal station by EUS requires adequate knowledge of anatomy as well as understanding the proper technique to perform EUS. This review presents a method to identify the regional nodal stations of GC by linear EUS and hence will help in appropriate N staging of GC.
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Praveer Rai
- Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
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Rameshbabu CS, Wani ZA, Rai P, Abdulqader A, Garg S, Sharma M. Standard imaging techniques for assessment of portal venous system and its tributaries by linear endoscopic ultrasound: a pictorial essay. Endosc Ultrasound 2014. [PMID: 24949362 DOI: 10.4103/2303-9027.117724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
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Affiliation(s)
- C S Rameshbabu
- Department of Anatomy, L.L.R.M., Medical College, Meerut 250001, U.P., India
| | - Zeeshn Ahamad Wani
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | | | - Almessabi Abdulqader
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Shubham Garg
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Malay Sharma
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
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Rameshbabu CS, Wani ZA, Rai P, Abdulqader A, Garg S, Sharma M. Standard imaging techniques for assessment of portal venous system and its tributaries by linear endoscopic ultrasound: a pictorial essay. Endosc Ultrasound 2014; 2:16-34. [PMID: 24949362 PMCID: PMC4062237 DOI: 10.7178/eus.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 01/08/2013] [Indexed: 12/12/2022] Open
Abstract
Linear Endosonography has been used to image the Portal Venous System but no established standard guidelines exist. This article presents techniques to visualize the portal venous system and its tributaries by linear endosonography. Attempt has been made to show most of the first order tributaries and some second order tributaries of splenic vein, superior mesenteric vein and portal vein.
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Affiliation(s)
- C S Rameshbabu
- Department of Anatomy, L.L.R.M., Medical College, Meerut 250001, U.P., India
| | - Zeeshn Ahamad Wani
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | | | - Almessabi Abdulqader
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Shubham Garg
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
| | - Malay Sharma
- Department of Anatomy, Jaswant Rai Speciality Hospital, Saket, Meerut 250001, Uttar Pradesh, India
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Sharma M, Rameshbabu CS. Collateral pathways in portal hypertension. J Clin Exp Hepatol 2012; 2:338-52. [PMID: 25755456 PMCID: PMC3940321 DOI: 10.1016/j.jceh.2012.08.001] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 08/16/2012] [Indexed: 12/12/2022] Open
Abstract
Presence of portosystemic collateral veins (PSCV) is common in portal hypertension due to cirrhosis. Physiologically, normal portosystemic anastomoses exist which exhibit hepatofugal flow. With the development of portal hypertension, transmission of backpressure leads to increased flow in these patent normal portosystemic anastomoses. In extrahepatic portal vein obstruction collateral circulation develops in a hepatopetal direction and portoportal pathways are frequently found. The objective of this review is to illustrate the various PSCV and portoportal collateral vein pathways pertinent to portal hypertension in liver cirrhosis and EHPVO.
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Key Words
- AIPDV, anterior inferior pancreatico duodenal vein
- ASPDV, anterior superior pancreatico duodenal vein
- AV, azygos vein
- BCS, Budd–Chiari syndrome
- CBD, common bile duct
- CT, computed tomography
- DV, duodenal varices
- ECD, epicholedochal
- EHPVO, extrahepatic portal vein obstruction
- ERVP, extrinsic rectal venous plexus
- FJT, first jejunal trunk
- GEV, gastroepiploeic vein
- GT, gastrocolic trunk
- GV, gastric varices
- IMV, inferior mesenteric vein
- IPDV, inferior pancreatico duodenal vein
- IRV, inferior rectal veins
- IRVP, intrinsic rectal venous plexus
- IVC, inferior vena cava
- LGEV, left gastroepiploic vein
- LGV, left gastric vein
- LPV, left portal vein
- MCV, middle colic vein
- PACD, paracholedochal
- PHB, portal hypertensive biliopathy
- PIPDV, posterior inferior pancreatico duodenal vein
- PPCV, portoportal collateral vein
- PSCV, portosystemic collateral veins
- PSPDV, posterior superior pancreatico duodenal vein
- PUV, paraumbilical vein
- PV, portal vein
- PVT, portal vein thrombosis
- RGEV, right gastroepiploic
- RGV, right gastric vein
- SMV, superior mesenteric vein
- SRV, superior rectal vein
- SV, splenic vein
- SVC, superior vena cava
- US, ultrasonography
- collateral pathways
- portal hypertension
- varices
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Saket, Meerut 250 001, Uttar Pradesh, India
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Sharma M, Mohan P, Rameshbabu CS, Jayanthi V. Identification of Perforators in Patients with Duodenal Varices by Endoscopic Ultrasound-A Case Series [with video]. J Clin Exp Hepatol 2012; 2:229-37. [PMID: 25755439 PMCID: PMC3940111 DOI: 10.1016/j.jceh.2012.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/08/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS Duodenal varices (DV) are ectopic varices which can cause massive gastrointestinal bleeding. The diagnosis of DV may be difficult; sometimes they can be hidden behind duodenal folds. The aim of the study was to evaluate DV by endoscopic ultrasound. METHODS Endoscopic ultrasound was done in patients detected or suspected to be having DV. The para duodenal varices were identified and subsequently hemodynamic evaluation of DV was done. RESULTS Endoscopic ultrasound identified perforators in seven cases of DV. CONCLUSION The endoscopic ultrasound can help in detection of DV underlying thickened folds. It can also help in hemodynamic evaluation of DV.
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Key Words
- CBD, common bile duct
- DV, duodenal varices
- ECD, epicholedochal
- EHPVO, extra hepatic portal vein obstruction
- EUS, Endoscopic ultrasound
- EVL, endoscopic variceal ligation
- HDA, hemodynamic assessment
- IVC, inferior vena cava
- PCD, para-choledochal
- PDV, paraduodenal varices
- PV, portal vein
- SMV, superior mesenteric vein
- duodenal varices
- endoscopic ultrasound
- endoscopic variceal ligation
- portal hypertension
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Affiliation(s)
- Malay Sharma
- Jaswant Rai Speciality Hospital, Saket, Meerut 250 001, Uttar Pradesh, India,Address for Correspondence: Dr. Malay Sharma, Gastroenterologist, Jaswant Rai Speciality Hospital, Saket, Meerut 250 001, Uttar Pradesh, India. Tel.: +91 9837031148 (mobile).
| | - Pazhanivel Mohan
- Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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