The correction of the right, liver see - twelve-finger editing varicose bleeding analysis.

The !---- case summary patient, a 54-year-old woman, was admitted to hospital for "blood for 1 week"a history of hepatitis B for 15 yearsbody: liver disease face, liver pals, spider mole, the lid conjunctiva slightly pale, heart and lung check body did not see obvious abnormality, liver ribs not touched, spleen under 3cm, mobile turbid negative, double lower extremities without edemalocal hospital gastroscopy suggests chronic superficial gastritis with decay, abdominal B super-tip liver light point increase, thickening, echo enhancement, large spleen, spleen vein diameter widening, ascites formation, gallbladder excision surgery, the liver inside and outside the bile duct does not expandadmission diagnosis consideration: gastrointestinal bleeding to be checked, hepatitis B cirrhosis? After gallbladder removalinpatient treatment after the patient was admitted to the hospital to be banned diet, acid suppression, vascular active drug growth inhibitor-suppressing vasculature pressure and rehydration support treatment after the bleeding gradually stoppedcombined with the local hospital gastroscopy results and abdominal ultrasound results, in order to further clarify the cause of bleeding, to review the gastroscopy if necessary to consider CT venous imaging (CTV)gastroscopy examination found esophageal varicose veins (moderate), varicose veins (moderate) at the bottom of the stomach, and varicose veins (severe) in the duodenum -debilitating segment (Figure 1)for further assessment of the duodenum-declining section of the varicose vein walking, further walking CTV examination prompt door vein high pressure, esophagus-gastric end vein varicose, gastric left vein into the spleen vein, intestinal membrane veins into the right kidney vein;combined with the patient's gastroscopy and CTV results, the 12-finger intestinal reduction segment varicose vein bleeding is very likely (Figure 2)Figure 1 Preoperative gastroscopic examination results Figure 2 Artenfront venous CTV test results after internal medicine conservative treatment patients still have a section of stool blood, combined with the patient's condition to consider there is still a higher risk of rebleeding, it is necessary to further walk intervention treatmentafter full communication with the patient and discussion sit until the professional group, decided to use the cervical liver internal body shunt (TIPS) joint spring ring embolism method for shunt and achieve complete hemorrhage (Figure 3)Afterthe diversion of the joint embolic veins, the patient's venous pressure was reduced from 18 mmHg before surgery to 15 mmHg, the lower cavity vein pressure was increased from 4 mmHg to 8 mmHg before surgery, and the pertinous pressure gradient of the door vein decreased by 50% compared to the preoperative procedure, and the shunt effect was satisfactorypatients also did not re-erate gastrointestinal bleeding, did not occur liver encephalopathy, smooth discharge from the hospitalfigure 3 TIPS combined spring ring treatment performance after 1 month after surgery review, no further blood, no liver encephalopathy, gastroscopy only see the lower section of the esophagus vaguely visible 2 discontinuous blue veins, gastric bottom varicose veins and duodenal disvesic venous veins disappeared (Figure 4);6 months after surgery, 12 months after the review of liver-free encephalopathy, no re-emitted blood, varicose veins basically disappeared, stent blood flow is smooth, liver work Child-Pugh B-grade Figure 4 1 month after the review of gastroscopy results 2 years after the review of the door venous imaging showed that the stent tube cavity smooth (Figure 5), check edpemia normal, liver function restored to Child-Pugh A-level, during which no liver encephalopathy, gastrointestinal bleeding occurred the current patient prognosis is good, regular follow-up in our hospital Figure 5 after 2 years of venous imaging show stent tube cavity smooth diagnosis and treatment analysis of this case to "blood" as the first symptom of admission, after examination comprehensive consideration may be caused by the duodenum varide bleeding, after TIPS joint spring ring embolism treatment without re-issued blood, after surgery patient regular follow-up, prognosis for gastrointestinal bleeding caused by this rare cause, what should we pay attention to in our daily clinical care? Duodenal varices (DV) was first reported by Medica and Warren in 1957 and first discovered in 1971 under the endoscopic mirror DV accounts for a lower proportion of all varicose bleeding, but once bleeding is difficult to control and even life-threatening The causes of the the formation of DV and the causes of DV formation in common sites are hepatic and intra-liver factors, and hepatic factors are related to menve thrombosis, menve tumor, congenital venous narrowness, hepatic extravehicular blocking, and intraliver factors are mainly caused by cirrhosis (this is the most common cause) most DVs are combined with varicose veins at the bottom of the esophagus, but also caused by esophageal varicose vein sclerosis treatment (possibly related to the diversion of venous pressure from the venous tract to the veins in the intestinal membrane) DV occurred in the most common part of the ball, followed by the lower, the horizontal and the upper part of the rare, individual cases can affect the entire duodenum different etiology may lead to the formation of DV in different sites (Table 1 4), and external factors in the liver are more at risk of DV than intra-liver factors Table 1 Different Etiology and DV Occurrence Location Note: Ld1 Twelve FingerS Sphere, Ld2 Twelve Finger Seropathic, Ld3 Twelve FingerS Level, Ld4 Twelve FingerS Elevated DV Bleeding Diagnostic Digestive Endoscopy is the preferred diagnostic method, can be used for the diagnosis and positioning of varicose veins, to observe the presence of varicose veins for rot, thrombosis and active bleeding for bleeding caused by varicose veins located at the level and upsection of the duodenum, it is usually diagnosed with a small intestine mirror if the endoscopy can not identify the cause of bleeding or can not timely emergency endoscopy, may consider the choice of enhanced CT or CT vascular imaging for examination, not only to identify the bleeding site, but also to further confirm the scope of varicose veins and traffic it is important to note that a small number of cases remain undiagnosed after the above tests the study of whether the LDRf (Location, Diameter, Risk Factor) type can cover the varicose varicose varicose veins of the digestive tract at the bottom of the esophagus, and found that the type is suitable for the whole digestive tract varicose veins, and has a certain clinical guiding effect on the treatment and timing of treatments including DV DV hemorrhage treatment at present, DV does not have a standard treatment plan, similar to the treatment of gastroesophageal varicose veins, including drug therapy, endoscopy, interventional embolism and surgery have its pros and cons in various treatments drug treatment as a first-line treatment plan, easy to be used clinically, including active capacity resuscitation, acid suppression, growth inhibitor sepsis to reduce the pressure of the vassals endoscopic therapy is mainly used for hemorrhage or prevention of bleeding of varicose veins, including varicose ligation, hardening agent blocking, titanium clip direct clamping and so on interventional therapy is usually suitable for endoscopic therapy at greater risk or when patients generally cannot tolerate surgery, tips can be selected, stent implantation, spleen artery embolism, lower cavity vein-intestinal membrane venous shunt, retrograde venous embolism, etc in the case of the above-mentioned treatment is ineffective, surgical treatment (e.g varicose vein ligation/removal, duodenal excision, procedure, etc.) may be used as a final remedial treatment, and the patient's liver function reserve must be fully assessed before surgery for patients in this case, preoperative CTV examination and found the existence of diversion, so in the choice of treatment measures did not choose the endoscopic intravascular tissue injection, using TIPS combined varicose vein spring ring embolism method, both to achieve the purpose of complete embolism and minimize the risk of ectopic embolism, but also greatly reduce the risk of venous pressure, reduce the risk of rebleeding experts introduced Li Weizhi Xi'an Jiaotong University First Affiliated Hospital Digestive Medicine European Cardiovascular and Interventional Radiology Society member China Research Hospital Association Interventional Medicine Professional Committee of the Chinese Anti-Cancer Association Cancer Interventional Professional Committee Youth Committee of the Chinese Association of Cancer Association Oncology Interventions Professional Committee of the High-Pressure Pulse Members of the Expert Committee of Shaanxi Province Anti-Cancer Association, the first anti-cancer association of the Youth Committee of the International Vascular Union Of China Branch of the Shaanxi Provincial Health Association, the member of the Shaanxi Provincial Association of Vascular Intervention Seinaves Professional Committee members mainly on chronic liver disease, cirrhosis, primary liver cancer and other clinical experience specializes in interventional radiation therapy, the conventional development of cervical venous hepatic intrauterine shunt (TIPS) treatment of liver cirrhosis digestive tract bleeding and liver cancer, pancreatic cancer, stomach cancer and other digestive tumors TACE treatment, a total of more than 3000 cases Source of Li Wei: The End of the Digest i.E !-- Content Presentation -- !-- Determine whether the login ends.