Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Apr 26:2022:7072961.
doi: 10.1155/2022/7072961. eCollection 2022.

Recurrent Ileal Variceal Bleeding as a Diagnostic and Therapeutic Challenge

Marek Cingel  1 , Jakub Benko  1 , Matej Samoš  1 , Marián Mokáň  1
Affiliations
Case Reports

Recurrent Ileal Variceal Bleeding as a Diagnostic and Therapeutic Challenge

Marek Cingel et al. Case Rep Gastrointest Med. .

Abstract

Introduction: Massive ileal variceal bleeding is a rare intricate condition that needs rapid management and treatment. The absence of randomized clinical trials in this field leads to a lack of evidence-based diagnostic and therapeutical approaches. We present a case report describing imaging, endoscopic, and surgical procedures leading to the diagnosis and resolution of severe ileal variceal bleeding. Case Report. We admitted a 63-year-old patient for recurrent anemia and ongoing bleeding from the gastrointestinal tract presenting as enterorrhagia. We were not able to elucidate the source by endoscopic, angiographic, or nuclear imaging methods. As a last resort, we carried out a surgical procedure with peroperative enteroscopy and subsequent resection of the affected part of the intestine.

Conclusion: We present a patient with a case of ileal variceal bleeding, which required extensive diagnostic and therapeutic effort with a unique peroperative enteroscopic approach.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
CT angiography showing a varix in the sac of the umbilical hernia.
Figure 2
Figure 2
Red blood cell nuclear scan showing variceal vessels in the area of the hernia.
Figure 3
Figure 3
The ileum with the identified varix.
Figure 4
Figure 4
Enteroscopy showing the nipple sign at the site of the varix.
Figure 5
Figure 5
The resected part of the ileum.
Figure 6
Figure 6
Histological examination of the resected part of the ileum.
See this image and copyright information in PMC

References

    1. Sharara A. I., Rockey D. C. Gastroesophageal variceal hemorrhage. New England Journal of Medicine . 2001;345(9):669–681. doi: 10.1056/NEJMra003007. - DOI
    1. Norton I. D., Andrews J. C., Kamath P. S. Management of ectopic varices. Hepatology . 1998;28(4):1154–1158. doi: 10.1002/hep.510280434. - DOI - PubMed
    1. Saad W. E. A., Lippert A., Saad N. E., Caldwell S. Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Techniques in Vascular and Interventional Radiology . 2013;16(2):108–125. doi: 10.1053/j.tvir.2013.02.004. - DOI
    1. Minowa K., Komatsu S., Takashina K., et al. Ectopic gastrointestinal variceal bleeding with portal hypertension. World Journal of Gastrointestinal Surgery . 2017;9(12):288–292. doi: 10.4240/wjgs.v9.i12.288. - DOI - PMC - PubMed
    1. De Palma G. D., Rega M., Masone S., et al. Mucosal abnormalities of the small bowel in patients with cirrhosis and portal hypertension: a capsule endoscopy study. Gastrointestinal Endoscopy . 2005;62(4):529–534. doi: 10.1016/s0016-5107(05)01588-9. - DOI - PubMed

Publication types