Jejunal Varices Bleeding in a Patient with Extensive Portomesenteric Thrombosis Secondary to Factor V Leiden Mutation: A Management Dilemma
Table 1
Main therapeutic options in the management of ectopic varices.
Therapeutic Options
Description
Pros
Cons
Endoscopic therapy
Use of band ligation, sclerotherapy or injection by cyanoacrylate.
Accessible. Available.
High risk of re-bleeding.
TIPS
Transjugular intrahepatic portal systemic shunting. It is a shunt creation procedure. Often combined with concomitant embolization for better success and reduction of rebleeding rates.
High success in selected patients. Can be used as primary modality or salvage therapy.
Requires Interventional radiologist. Not suitable in occlusive type of varices.
BRTO
Balloon occluded retrograde transvenous obliteration. A shunt closure procedure.
High success in gastric varices. Reported cases of success in Ectopic intestinal varices.
Requires Expert Interventional radiologist. Non-feasible in occluded type of varices.
Surgical Resection
Surgical removal of the bleeding segment
Potentially a definitive therapy. Low risk of recurrence.
Risks associated with a major intestinal surgery. Less suitable if cirrhotic. Usually a salvage therapy.
