Published online Dec 26, 2018. doi: 10.12998/wjcc.v6.i16.1217
Peer-review started: October 2, 2018
First decision: October 18, 2018
Revised: November 20, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 26, 2018
Duodenal varices are a lesser-known complication with non-cirrhotic portal hypertension. We report a circuitous route from missed diagnosis of duodenal varices to correction. An extremely rare case of duodenal variceal bleeding secondary to idiopathic portal hypertension (IPH) is expounded in this study, which was controlled by transjugular intra-hepatic porto-systemic shunt (TIPS) plus embolization.
A 46-year-old woman with anemia for two years was frequently admitted to the local hospital. Upon examination, anemia was attributed to gastrointestinal tract bleeding, which resulted from duodenal variceal bleeding detected by repeated esophagogastroduodenoscopy. At the end of a complete workup, IPH leading to duodenal varices was diagnosed. Portal venography revealed that the remarked duodenal varices originated from the proximal superior mesenteric vein. TIPS plus embolization with coils and Histoacryl was performed to obliterate the rupture of duodenal varices. The anemia resolved, and the duodenal varices completely vanished by 2 mo after the initial operation.
TIPS plus embolization may be more appropriate to treat the bleeding of large duodenal varices.
Core tip: Duodenal varices are a lesser-known complication of non-cirrhotic portal hypertension. The authors report a complicated case of duodenal varices secondary to idiopathic portal hypertension in a patient with recurrent anemia for two years, which were undetected by the endoscopist at a local hospital, but observed by repeated endoscopy in the digestive department in our hospital. The duodenal varices were arrested by transjugular intra-hepatic porto-systemic shunt plus embolization. To the best of the authors’ knowledge, this is the first report to explore transjugular intra-hepatic porto-systemic shunt treatment for duodenal varices secondary to idiopathic portal hypertension.