A rare case of obscure gastrointestinal bleeding: Small bowel varices flowing into the inferior epigastric vein [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. 2017; 23(3): 266-268 | DOI: 10.5505/tjtes.2016.01394  

A rare case of obscure gastrointestinal bleeding: Small bowel varices flowing into the inferior epigastric vein

Akira Hoshiai1, Junya Tsurukiri1, Yasuhiro Sumi2
1Department of Emergency and Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Tokyo-Japan
2Department of General Surgery, Shizuoka Medical Center, Shizuoka-Japan

Ectopic varices include all varices except esophageal or gastric varices and comprise large portosystemic venous collaterals that occur anywhere in the abdomen. Ectopic varices are relatively rare; however, approximately 5% are related to gastrointestinal bleeding. Ectopic varices usually occur in the rectum, duodenum, or colon, and portal hypertension is the most common cause. Hemodynamic profiles of ectopic varices remain unknown, and extensive bleeding from these structures occurs because diagnosis and treatment are difficult. Here we report a case of obscure gastrointestinal bleeding (GIB) due to ectopic varices in the small intestine that flowed into the inferior epigastric vein. Our observations suggest that when obscure GIB is detected in patients with either cirrhosis or post-surgical history including incisional hernia, it is essential to acquire multilanar reconstruction images and volume-rendered 3-dimensional reconstruction of computed tomography scans to investigate the complex venous supply and optimize decisions for therapy.

Keywords: ectopic varices, submucosal varices, cirrhosis, portal hypertention, incisional hernia


Akira Hoshiai, Junya Tsurukiri, Yasuhiro Sumi. A rare case of obscure gastrointestinal bleeding: Small bowel varices flowing into the inferior epigastric vein. Ulus Travma Acil Cerrahi Derg. 2017; 23(3): 266-268

Corresponding Author: Junya Tsurukiri, Japan


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