Quick-soluble gelatin sponge particles for mesenteric variceal bleeding after portal vein thrombosis
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Small bowel varices, while uncommon, can cause significant gastrointestinal bleeding, particularly in patients with portal hypertension. This report presents a case of recurrent small bowel variceal bleeding in a liver transplant recipient with chronic portal and mesenteric venous thrombosis, unresponsive to previous coil embolization attempts. Due to the lack of feasible venous access, a transarterial embolization strategy was employed, combining quick-soluble gelatin sponge particles (QS-GSP) to fill the varices with n-butyl cyanoacrylate (NBCA) to embolize the arterial feeders. This method achieved complete devascularization, resulting in immediate cessation of bleeding. However, the patient subsequently developed bowel ischemia, necessitating surgical resection of a 90-cm segment of jejunum. No rebleeding occurred during an 8-month follow-up period. In complex variceal bleeding unresponsive to conventional methods, a combined QS-GSP and NBCA embolization technique may provide effective hemostasis, although the risk of ischemic complications must be carefully considered.
Abstract
Small bowel varices, while uncommon, can cause significant gastrointestinal bleeding, particularly in patients with portal hypertension. This report presents a case of recurrent small bowel variceal bleeding in a liver transplant recipient with chronic portal and mesenteric venous thrombosis, unresponsive to previous coil embolization attempts. Due to the lack of feasible venous access, a transarterial embolization strategy was employed, combining quick-soluble gelatin sponge particles (QS-GSP) to fill the varices with n-butyl cyanoacrylate (NBCA) to embolize the arterial feeders. This method achieved complete devascularization, resulting in immediate cessation of bleeding. However, the patient subsequently developed bowel ischemia, necessitating surgical resection of a 90-cm segment of jejunum. No rebleeding occurred during an 8-month follow-up period. In complex variceal bleeding unresponsive to conventional methods, a combined QS-GSP and NBCA embolization technique may provide effective hemostasis, although the risk of ischemic complications must be carefully considered.