Journal of Medical Case Reports | |
Small bowel varices secondary to chronic superior mesenteric vein thrombosis in a patient with heterozygous Factor V Leiden mutation: a case report | |
David van der Poorten3 Hema Mahajan1 Golo Ahlenstiel3 Maria C. Garcia2 | |
[1] Department of Anatomical Pathology, Westmead Hospital, Westmead, NSW, Australia;Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, NSW, Australia;Department of Gastroenterology and Hepatology, University of Sydney at Westmead Hospital, Westmead, NSW, Australia | |
关键词: Superior mesenteric vein thrombosis; Factor V Leiden; Ectopic varices; | |
Others : 1233286 DOI : 10.1186/s13256-015-0705-6 |
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received in 2015-04-21, accepted in 2015-09-02, 发布年份 2015 | |
【 摘 要 】
Introduction
Bleeding ectopic small bowel varices pose a clinical dilemma for the physician, given their diagnostic obscurity and the lack of evidence-based medicine to guide therapy. They often occur in the context of portal hypertension, secondary to either liver disease or extrahepatic causes. Rarely is their presence associated with chronic superior mesenteric vein thrombosis and hereditary coagulopathies.
Case presentation
A 74-year-old white woman, with a heterozygous Factor V Leiden mutation and no underlying liver disease or portal hypertension, presented over the course of 13 months for recurrent episodes of melena and per rectal bleeding. An initial endoscopy showed a clean-based chronic gastric ulcer, while colonoscopies showed multiple, non-bleeding angioectasias which were treated with argon plasma coagulation. Subsequent video capsule endoscopy and double balloon enteroscopy revealed red wale marks overlying engorged submucosal veins in her distal ileum, consistent with ectopic varices. A chronic superior mesenteric vein thrombus, found via computed tomography venogram, was the cause of the ileal varices. She underwent curative surgical resection of the affected bowel, with no re-bleeding episodes 17 months post-surgery, despite needing lifelong anticoagulation for recurrent venous thromboembolisms.
Conclusions
Clinicians should consider ectopic varices in patients who present with obscure gastrointestinal bleeding, even in the absence of portal hypertension or liver disease. In those with a known thrombophilia, patients should be screened for splanchnic thrombosis, which may precipitate ectopic varices.
【 授权许可】
2015 Garcia et al.
【 预 览 】
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20151119092135543.pdf | 2229KB | download | |
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Fig. 1. | 47KB | Image | download |
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