A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices
Joint Authors
Nguyen, Lam-Phuong
Sriratanaviriyakul, Narin
Sandrock, Christian
Source
Issue
Vol. 2016, Issue 2016 (31 Dec. 2016), pp.1-4, 4 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2016-02-18
Country of Publication
Egypt
No. of Pages
4
Main Subjects
Abstract EN
“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding and are generally due to obstruction of the superior vena cava (SVC).
Often these cases of “downhill” varices are missed diagnoses as portal hypertension but fail to improve with medical treatment to reduce portal pressure.
We report a similar case where recurrent variceal bleeding was initially diagnosed as portal hypertension but later found to have SVC thrombosis presenting with recurrent hematemesis.
A 39-year-old female with history of end-stage renal disease presented with recurrent hematemesis.
Esophagogastroduodenoscopy (EGD) revealed multiple varices.
Banding and sclerotherapy were performed.
Extensive evaluation did not show overt portal hypertension or cirrhosis.
Due to ongoing bleeding requiring resuscitation, she underwent internal jugular (IJ) and SVC venogram in preparation for transjugular intrahepatic portosystemic shunt (TIPS), which demonstrated complete IJ and SVC occlusion.
She underwent balloon angioplasty with stent placement across SVC occlusion with complete resolution of her varices and resolved hematemesis.
“Downhill” varices are extremely rare, though previously well described.
Frequently, patients are misdiagnosed with underlying liver disease.
High index of suspicion and investigation of alternative causes of varices is prudent in those without underlying liver diseases.
Prompt diagnosis and appropriate intervention can significantly improve morbidity and mortality.
American Psychological Association (APA)
Nguyen, Lam-Phuong& Sriratanaviriyakul, Narin& Sandrock, Christian. 2016. A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices. Case Reports in Critical Care،Vol. 2016, no. 2016, pp.1-4.
https://search.emarefa.net/detail/BIM-1100425
Modern Language Association (MLA)
Nguyen, Lam-Phuong…[et al.]. A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices. Case Reports in Critical Care No. 2016 (2016), pp.1-4.
https://search.emarefa.net/detail/BIM-1100425
American Medical Association (AMA)
Nguyen, Lam-Phuong& Sriratanaviriyakul, Narin& Sandrock, Christian. A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices. Case Reports in Critical Care. 2016. Vol. 2016, no. 2016, pp.1-4.
https://search.emarefa.net/detail/BIM-1100425
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1100425