Massive duodenal variceal hemorrhage in a patient with prior Roux-en-Y gastric bypass

• Main Authors: Kiran Sinjali, BS, Chris Bent, MD
• Format: Article
• Language: English
• Published: Elsevier 2021-11-01
• Series: Radiology Case Reports
• Subjects: Duodenal variceal bleeding; Ectopic varices; Percutaneous transhepatic embolization; Transjugular intrahepatic portosystemic shunt; Roux-en-Y gastric bypass; Portosystemic pressure gradient
• Online Access: http://www.sciencedirect.com/science/article/pii/S1930043321005616

Duodenal variceal bleeding is a rare form of variceal bleeding which may be fatal if left untreated. There are no specific guidelines available for their treatment. Medical management, surgical, endoscopic, and interventional radiological procedures have been utilized with varied outcomes. In this case summary we report the successful management of duodenal variceal bleeding in a patient with prior Roux-en-Y gastric bypass . The patient with history of cirrhosis presented with acute gastrointestinal bleeding. Esophagogastroduodenoscopy and colonoscopy could not locate the source of bleeding. Computed tomography of the abdomen demonstrated a large duodenal variceal complex. Interventional radiology (IR) treated the patient with a combination of percutaneous transhepatic embolization and subsequent transjugular intrahepatic portosystemic shunt . No recurrence of gastrointestinal bleeding was noted at follow up. This case demonstrates that percutaneous transhepatic embolization along with transjugular intrahepatic portosystemic shunt may be effective treatment of duodenal variceal bleeding.