Massive hemorrhage from jejunal varices
Scheppach, W.; Wittenberg, G.; Hahn, D.; Langenfeld, H.; Burghardt, W.; Van Aerssen, M.; Ott, G.; Thiede, A.; Kasper, H.
Zeitschrift für Gastroenterologie 35(3): 195-198
1997
ISSN/ISBN: 0044-2771 PMID: 9173688 Document Number: 471682
A 21-year-old male presented with melaena and signs of hemorrhagic shock. In the following days several episodes of hematochezia occurred requiring the transfusion of nine units of blood. Findings at gastroscopy were normal, at colonoscopy fresh blood was noted from the ileocecal valve. Angiography performed in a bleeding-free interval showed no abnormalities. At repeat angiography, bleeding (from a left lateral branch of the superior mesenteric artery) was provoked by instillation of plasminogen activator. Subsequently, hemostasis was achieved by superselective embolization using coils. At operation one week later, a polypoid tumor of 1 cm diameter was resected along with a 4 cm segment of adjacent jejunum (40 cm distal to the ligament of Treitz). Histologically, a jejunal varix with superficial ulceration was diagnosed.