Endoscopic Sclerotherapy with a Large Volume of High Concentration of Cyanoacrylate for Jejunal Variceal Bleeding bys Single-Balloon Enteroscopy

Abstract

Jejunal varices are a rare manifestation of portal hypertension, and they are associated with a high mortality and poor prognosis when bleeding occurs. A bleeding jejunal varix is much more challenging to diagnose and manage because of its anatomic location. Herein, we describe the case of a 62-year-old man with active jejunal variceal bleeding who presented with massive hematochezia and hypovolemic shock. He was treated successfully with a high volume and concentration of a glue mixture as endoscopic sclerotherapy using single-balloon enteroscopy in the intensive care unit. Enteroscopic sclerotherapy is an effective option for jejunal variceal bleeding.

Keywords: jejunal varices; sclerotherapy; single-balloon enteroscopy.

Figure 1

One engorged cystic lesion with persistent bleeding from the central depression observed in the proximal jejunum with single-balloon enteroscopy.

Figure 2

After the first attempt of sclerotherapy, jejunal variceal bleeding persists.

Figure 3

The sclerosant fills the varices and bleeding ceases after the second attempt of sclerotherapy.

Figure 4

Abdominal contrast-enhanced computed tomography scan confirms the deposition of dense lipiodol in the proximal jejunum four days after sclerotherapy. The previous transcatheter arterial embolization caused some deposition of lipiodol in the liver, and the amount is unchanged from that observed in the prior image.