A Case of Duodenal Varices Successfully Treated by Intraoperative Ligation and Injection Sclerotherapy

Hirochika Makino, Chikara Kunisaki, Hidenori Masui, Shinji Togo and Hiroshi Shimada

The Second Department of Surgery, Yokohama City University School of Medicine

A 65-year-old male who was followed-up for liver cirrhosis by another hospital, was admitted to our hospital for melena and anemia. Upper gastrointestinal endoscopy revealed enlarged and tortuous varices in the descending portion of the duodenum. Hypotonic duodenogram demonstrated a filling defect with well-defined margins and smooth surfaces in the descending portion of the duodenum. A percutaneous transhepatic portogram revealed duodenal varices that were mainly supplied via the posterior inferior pancreaticoduodenal vein that drained to the testicular vein. Duodenal varices were treated by percutaneous transhepatic portal obliteration. His symptoms temporaily were relieved, but two months later, during a regular checkup at our outpatient the melena and anemia recurred. So, he was readmitted to our hospital. After readmission, a testiculovenogram revealed that the duodenal varices remained. Intraoperative injection sclerotherapy was selected as a safe treatment. We injected 5 ml of ethanolaminoleate intravariceally after ligation and resection of the varices. The postoperative course progressed favorably, even through a duodenal ulcer developed. No recurrence of the duodenal varices has been detected during the follow-up period of two years after intraoperative injection sclerotherapy. In conclusion, intraoperative ligation and injection sclerotherapy is a safe, sure, and useful method for treatment of duodenal varices.

Key words
duodenal varices, gastrointestinal bleeding, portal hypertention

Reprint requests
Hirochika Makino Department of Surgery, Yokohama National Hospital 252 Harajuku-cho, Totsuka-ku, Yokohama-city, 245-8575 JAPAN

Accepted
July 28, 1999

To read the PDF file you will need Abobe Reader installed on your computer.