0
Critical Care |

Mesenteric Variceal Bleeding Presenting as Massive Gastrointestinal Bleeding

Sumera Ahmad, MBBS; Jonathan Holdorf, MD; Paulo Oliveira, MD
Author and Funding Information

University of Massachusettes, Worcester, MA


Chest. 2015;148(4_MeetingAbstracts):211A. doi:10.1378/chest.2229651
Text Size: A A A
Published online

Abstract

SESSION TITLE: Critical Care Cases II

SESSION TYPE: Affiliate Case Report Slide

PRESENTED ON: Monday, October 26, 2015 at 03:15 PM - 04:15 PM

INTRODUCTION: Mesenteric varices are an unusual cause of gastrointestinal (GI) bleeding,but associated with a high mortality.We describe a case,where massive GI bleeding was encountered in the setting of mesenteric varices.

CASE PRESENTATION: A 68-year-old woman presented with complaint of passing blood per rectum for four days prior.She had known hepatitis C cirrhosis and grade 3 esophageal varices.Physical exam was remarkable for pallor.Initial laboratory tests were significant for refractory anemia. An esophagogastroduodenoscopy (EGD) was negative.A colonoscopy showed diverticula but no active bleed.A video-capsule study revealed bleeding from the right side of the colon.She had persistent hematochezia needing support with massive transfusion and octreotide infusion for suspected variceal bleeding.An aortogram combined with a celiac,superior mesenteric and inferior mesenteric arteriogram,was negative for a source of bleeding.A repeat EGD revealed a normal esophagus,but active bleeding was noted upon entering the third portion of the duodenum obscuring visualisation.She was taken for a computed tomographic angiogram (CTA) of the abdomen that demonstrated on the delayed phase sequence images,dilated mesenteric veins representing the source of bleeding (Figure 1). Portal hemodynamic measurement revealed portal hypertension.Transjugular intrahepatic portosystemic shunt (TIPS) was created,achieving resolution of portal hypertension and hemostasis.

DISCUSSION: Ectopic varices,consisting of mesenteric and duodenal varices,are rare,representing up to 5% of all variceal bleeding.It is associated with a high mortality of up to 40% and frequently diagnosed upon surgery or autopsy. The most common cause is portal hypertension,though mesenteric vein thrombosis,congenital malformations, arteriovenous fistulas and adhesions from prior surgeries represent other rare causes.Diagnosis involves EGD,though CTA has been reported increasingly useful.Treatment includes the use of vasoactive medication.TIPS with or without embolization of the bleeding varices has been reported to be successful in several case reports and case series.

CONCLUSIONS: We present a case of mesenteric varices manifesting as massive lower GI bleeding,which was eventually diagnosed with the help of an EGD and a CTA and treated with TIPS.

Reference #1: Lopera JE,et al.Bleeding duodenal:varices treatment by TIPS and transcatheter embolization.Cardiovasc Intervent Radiol.2008;31(2):431-434.

Reference #2: Norton ID,et al.Management of ectopic varices.Hepatology.1998;28(4):1154-1158.

DISCLOSURE: The following authors have nothing to disclose: Sumera Ahmad, Jonathan Holdorf, Paulo Oliveira

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543