Successful Endoscopic Treatment of Bleeding Anorectal Varices in a patient with Advanced Pancreatic Cancer

Masayuki Nakanowatari, Takahiro Sato, Michio Iida, Jiro Honma, Takashi Fukuhara

Abstract


A 78-year-old female with massive hematochezia showed an extra-hepatic portal vein obstruction (EHO) and rectal varices due to advanced pancreatic cancer with computed tomography (CT).  Endoscopy revealed enlarged rectal varices and external anal varices with a reddish fibrin plug, and we diagnosed the rupture of anorectal varices near the anal verge.  We first performed endoscopic injection sclerotherapy (EIS) for rectal varices under fluoroscopy.  After EIS, endoscopic variceal ligation (EVL) was performed for the fibrin plug.  Following treatment, the patient experienced no further episodes of bleeding during the three months up to her death.

Keywords


Rectal varices; Ectopic varices; Advanced pancreatic cancer; Extra-hepatic portal vein obstruction; Portal hypertension

References


 Shudo R, Yazaki Y, Sakurai S, Uenishi H, Yamada H, Sugawara K. Clinical study comparing bleeding and nonbleeding rectal varices. Endoscopy 2002; 34(3): 189-194

 Rabinovitz M, Schade RR, Dindzans VJ, Belle SH, Van Thiel DH, Gavaler JS. Colonic disease in cirrhosis. Gastroenterology 1990; 99: 195-199

 Watanabe N, Toyonaga A, Oho K, Kokubo S, Nakamura K, Hasumi A, Murashima N, Tajiri T. The present state of ectopic varices in Japan: the results of the questionnaire survey. JJPH 2009; 15: 131-142 (in Japanese)

 Hosking SW, Smart HL, Johnson AG, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet 1989; 18: 349-352

 McCormack TT, Bailey HR, Simms JM, Johnson AG. Rectal varices are not piles. Br J Surg 1984; 71: 163

 Sato T, Yamazaki K, Toyota J, Karino Y, Ohmura T, Suga T. The value of the endoscopic therapies in the treatment of rectal varices: a retrospective comparison between injection sclerotherapy and band ligation. Hepatol Res 2006; 34: 250-255

 Maslekar S, Toh EW, Adair R, Bate JP, Botterill I. Systematic review of anorectal varices. Colorectal Dis 2013; 15: 702-710

 Sato T, Yamazaki K, Akaike J, Arakawa T, Kuwata Y, Nakajima T, Ozeki I, Ohmura T, Karino Y, Toyota J. Diagnosis and treatment of rectal varices. Syoukaki Naishikyou 2010; 25(11): 1845-1850 (in Japanese, Abstract in English) 

 Sato T, Yamazaki K, Akaike J. Evaluation of the hemodynamics of rectal varices by endoscopic ultrasonography. J Gastroenterol 2006; 41: 588-592


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