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Jejunal varices: an unconsidered cause of recurrent gastrointestinal haemorrhage
  1. Caleb Joseph Heiberger1,
  2. Tej Ishaan Mehta1 and
  3. Douglas Yim2
  1. 1 Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA
  2. 2 Department of Interventional Radiology, Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota, USA
  1. Correspondence to Tej Ishaan Mehta, tej.mehta{at}


A 78-year-old woman presented with melaenic stool and severe anaemia 4 years after a pancreaticoduodenectomy for adenocarcinoma of the pancreas. Initial workup revealed haemorrhage from the choledochojejunostomy site. Despite multiple endoscopic clips to the region, bleeding reoccurred multiple times over a period of several months. Due to ongoing haemorrhage, her case was urgently presented at the hospital’s multidisciplinary hepatobiliary conference. The contrast-enhanced abdominal CT revealed severe stenosis of the extrahepatic portal vein and large afferent jejunal varices at the choledochojejunostomy, suspected as the cause of her persistent bleed. The recommendation was a percutaneous transhepatic approach for stenting of the portal vein stenosis that resulted in rapid decompression of the jejunal varices and control of her haemorrhage.

  • interventional radiology
  • GI bleeding
  • varices

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  • Contributors DY performed the case and provided review and editorial assistance. TM provided review and editorial assistance. CJH wrote the case report and discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

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

  • Patient consent for publication Obtained.