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  • Bleeding ectopic duodenal varix: use of a new microvascular plug (MVP) device along with transjugular intrahepatic portosystemic shunt (TIPSS)

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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Bleeding ectopic duodenal varix: use of a new microvascular plug (MVP) device along with transjugular intrahepatic portosystemic shunt (TIPSS)
  1. Richa Bhardwaj1,
  2. Gaurav Bhardwaj2,
  3. Erik Bee3,
  4. Raffi Karagozian4
  1. 1Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut, USA
  2. 2Department of Gastroenterology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
  3. 3Department of Radiology, Saint Francis Hospital and Medical Center, Hartford, Connecticut, USA
  4. 4Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut, USA
  1. Correspondence to Dr Richa Bhardwaj, dr.richabhardwaj{at}gmail.com

Summary

Ectopic varices (ECV) occur along the gastrointestinal (GI) tract outside the common variceal sites and represent 2%–5% of all GI variceal bleeds with mortality rates up to 40%. Management is challenging because of inaccessibility and increased risk of rebleeding. We report what is to our knowledge the first clinical use of a new microvascular plug (MVP) with transjugular intrahepatic portosystemic shunt (TIPSS) for a bleeding duodenal varix (DV). A 68-year-old man presented with melena. Endoscopy demonstrated a grade II varix in the second part of the duodenum with red wale sign. TIPSS was performed and portogram revealed a single DV. Poststent placement venogram revealed a persistent varix and hence a 5–7 mm MVP was deployed. Subsequent imaging showed cessation of blood through the DV. The patient had no further bleeding. TIPSS with embolisation is an effective treatment for ECV. This MVP offers advantages due to its size and compatibility and can be redeployed in case of suboptimal placement.

  • varices
  • Gi bleeding
  • cirrhosis

https://doi.org/10.1136/bcr-2017-221200

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    Footnotes

    • Contributors RB: Collection of data, manuscript writing, drafting the article. GB: Revision of manuscript, material support. EB: Radiology inputs, material support. RK: Conception and design, revising the article for important intellectual content, critical revisions, clinical oversight and approval.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.