An unusual case of severe gastrointestinal bleeding

Abstract

We present the case of a 58-year-old female with a history of a bleeding duodenal peptic ulcer. Endoscopic hemostasis was unsuccessful; therefore, a transcatheter arterial embolization of a culprit vessel was performed. She was admitted to the hospital two months later because of obstruction of the common bile duct with cholangitis. Attempts to endoscopically place a biliary stent failed. The treating medical team opted for a surgical choledocho-jejunostomy. After 20 months, she presented with a melena and a severe anemia. Diagnostic work-up revealed portal vein thrombosis with portal cavernoma and bleeding choledocho-jejunostomy varices. The case presents and discusses rare complications of duodenal ulcer disease, as well as possible causes and treatment options.

Zusammenfassung

Wir stellen Ihnen eine 58–jährige Patientin vor, die von einem Zwölffingerdarmgeschwür blutete. Die endoskopische Hämostase war nicht erfolgreich, deswegen war eine Transkatheter-arterielle Embolisation notwendig. Die Patientin musste zwei Monate später wegen Obstruktion und Entzündung der Gallenwege hospitalisiert werden. Eine Spiegelung der Gallenwege und des Bauchspeicheldrüsenganges mit der Stent-Einsetzung war nicht möglich. Deswegen brauchte sie eine chirurgische Choledochojejunostomie. Sie wurde 20 Monate später wieder im Krankenhaus aufgenommen, dieses Mal wegen Meläna und schwerer Anämie. Mit den Untersuchungen wurde Pfortaderthrombose mit einem Portal-Kavernom und Blutung aus den Varizen um die Choledochojejunostomie diagnostiziert. Mit diesem Beispiel möchten wir eine seltene Komplikation des Zwölffingerdarmgeschwürs darstellen und mögliche Ursachen und Behandlungsmöglichkeiten diskutieren.

Schlüsselwörter

bleeding jejunal varices - Zwölffingerdarmgeschwür - chirurgische Choledochojejunostomie - Pfortaderthrombose - Portal-Kavernom - Blutung aus Jejunalvarizen

Keywords

duodenal ulcer - choledocho-jejunostomy - portal vein thrombosis - portal cavernoma

Publication History

Received: 26 June 2023

Article published online:
26 September 2023

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