Duodenal and jejunal varices due to superior mesenteric vein thrombosis presenting as a massive gastrointestinal tract bleeding: a case report

Beyza Ozcinar 1 , Kemal Dolay 1 , Hakan Yanar 1 , Korhan Taviloglu 1 , Cemalettin Ertekin 1 , Adem Ucar 2 , Recep Guloglu 1 , Rebecca Plevin 3 ,  and Mehmet Kurtoglu 1
  • 1 Istanbul Faculty of Medicine, Trauma and Emergency Medicine Service, Istanbul University, 34190, Istanbul, Turkey
  • 2 Istanbul Faculty of Medicine, Radiodiagnostic Department, Istanbul University, 34190, Istanbul, Turkey
  • 3 Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, 90007, USA


Duodenal and jejunal varices usually occur due to portal hypertension and are rare causes of gastrointestinal tract bleeding. We report the case of a patient with no clinically significant history of a coagulopathy disorder, cirrhosis, or portal hypertension who presented with duodenal and jejunal varices that resulted in lower gastrointestinal bleeding with superior mesenteric vein thrombosis. Mesenteric angiography revealed superior mesenteric vein thrombosis and varices at the fourth part of the duodenum and the proximal jejunum draining into the main portal vein, but no active bleeding source was recognized. The patient was hemodynamically unstable. Emergency laparotomy was performed and revealed duodenal and jejunal varices, with occlusion of the superior mesenteric vein. Partial resection of the duodenum and jejunum and end-to-end anastomosis were performed. After surgery, the patient was hemodynamically stable with no recurrence of bleeding.

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  • [1] Cottam DR, Clark R, Hayn E, Shaftan G. Duodenal varices: a novel treatment and literature review. Am Surg. 2002;68(5):407–409

  • [2] Yuki N, Kubo M, Noro Y, Kasahara A, Hayashi N, Fusamoto H, Ito T, Kamada T. Jejunal varices as a cause of massive gastrointestinal bleeding. Am J Gastroenterol. 1992;87(4):514–517

  • [3] Reis HE, Moschinski D, Borchard F. Isolated varicosis of the small intestine (without portal hypertension) causing massive upper gastrointestinal bleeding. Leber Magen Darm. 4 1982;12:23–31

  • [4] Eriguchi N, Aoyagi S, Hara M, Miyazaki T, Tanaka M, Toyonaga A. Jejunal varices as a cause of massive gastrointestinal bleeding: a case report. Kurume Med J. 1998;45(2):227–230

  • [5] Hamlyn AN, Lunzer MR, Morris JS. Portal Hypertension varices in unusual sites. Lancet 1974; 2:1531–15347 http://dx.doi.org/10.1016/S0140-6736(74)90283-9

  • [6] Harward TR, Green D, Bergan JJ, Rizzo RJ, Yao JS. 6.Mesenteric venous thrombosis. J Vasc Surg. 1989;9(2):328–333 http://dx.doi.org/10.1067/mva.1989.vs0090328

  • [7] Berney T, Morales M, Broquet PE, Mentha G, Morel P. Risk factors influencing the outcome of portal and mesenteric vein thrombosis. Hepatogastroenterology. 1998;45:2275–2281

  • [8] Moncure AC, Waltman AC, Vandersalm TJ, Linton RR, Levine FH, Abbott WM. Gastrointestinal hemorrhage from adhesion-related mesenteric varices. Ann Surg. 1976;183(1):24–29 http://dx.doi.org/10.1097/00000658-197601000-00005

  • [9] Perea Garcia J, Lago Oliver J, Munoz Jimenez F, del Valle E, Duque Perez C, Turegano Fuentes F. Low gastrointestinal bleeding due to ectopic varices as a result of adhesions] Gastroenterol Hepatol. 2000;23(6):287–289

  • [10] Mitchell AW, Jackson JE. Trans-anastomotic portoportal varices in patients with gastrointestinal haemorrhage. Clin Radiol. 2000;55:207–211 http://dx.doi.org/10.1053/crad.1999.0347

  • [11] Tang NC, Ibrahim S, Tay KH. Successful management of a bleeding duodenal varix by endoscopic banding. Singapore Med J. 2005;46(12):723–725

  • [12] AGA. American gastroenterological association medical position statement: evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 2000;118:197–201 http://dx.doi.org/10.1016/S0016-5085(00)70429-X

  • [13] Lin S, Rockey DC. Obscure Gastrointestinal Bleeding. Gastroenterol Clin N Am 2005; 34:679–698 http://dx.doi.org/10.1016/j.gtc.2005.08.005

  • [14] Rollins ES, Picus D, Hicks ME, et al. Angiography is useful in detecting the source of chronic gastrointestinal bleeding of obscure origin. AJR Am J Roentgenol 1991;156:385–388

  • [15] Moore JD, Thompson NW, Appleman HD, et al. Arteriovenous malformations of the gastrointestinal tract. Arch Surg 1976;111:381–389

  • [16] Joo YE, Kim HS, Choi SK, Rew JS, Kim HR, Kim SJ. Massive gastrointestinal bleeding from jejunal varices. J Gastroenterol. 2000;35(10):775–778 http://dx.doi.org/10.1007/s005350070037

  • [17] Khouqeer F, Morrow C, Jordan P. Duodenal varices as a cause of massive upper gastrointestinal bleeding. Surgery. 1987;102(3):548–552

  • [18] Tang SJ, Jutabha R, Jensen DM. Push enteroscopy for recurrent gastrointestinal hemorrhage due to jejunal anastomotic varices: a case report and review of the literature. Endoscopy. 2002;34(9):735–737 http://dx.doi.org/10.1055/s-2002-33448

  • [19] Jonnalagadda SS, Quiason S, Smith OJ. Successful therapy of bleeding duodenal varices by TIPS after failure of sclerotherapy. Am J Gastroenterol. 1998 Feb;93(2):272–274 http://dx.doi.org/10.1111/j.1572-0241.1998.270_3.x


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