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Therapeutic Strategy for Patients with Bleeding Rectal Varices Complicating Liver Cirrhosis.
MedLine Citation:
PMID:  24033909     Owner:  NLM     Status:  Publisher    
AIM: Although rupture of rectal varices is rarely encountered, it may provoke massive and fatal hemorrhage in patients with liver cirrhosis. We examined the clinical features of patients showing bleeding from rectal varices to establish a suitable therapeutic strategy for the lesions.
METHODS: Twelve cirrhotic patients with bleeding rectal varices were enrolled. One of surgical suture, EVL or balloon tamponade was performed to achieve the initial hemostasis. Then, the feeding and drainage vessels of the varices were evaluated by CT, and additional procedures were undertaken: EVL was performed when the sizes of the varices and feeding vessels were small. In contrast, in patients with varices of large sizes, B-RTO was performed when single or two drainage vessels were identified, while EIS using ethanolamine oleate was carried out for varices with 3 or more drainage vessels.
RESULTS: The Child-Pugh class was grade A in 4, B in 6, and C in 2 patients. Of all the patients, 11 patients had received previous therapy for esophageal varices. Initial hemostasis was achieved by surgical suture in 3 patients, EVL in 1 patient and balloon tamponade in 2 patients. EVL, EIS and B-RTO were carried out as additional procedures in 7, 3 and 1 patient(s), respectively. Re-bleeding from the rectal varices occurred in only one patient who underwent EVL as an additional procedure.
CONCLUSION: Bleeding from rectal varices was controlled satisfactorily by the therapeutic strategy of selecting EVL, EIS or B-RTO as an additional therapy according to the size and hemodynamics of the varices.
Kiyoko Yoshino; Yukinori Imai; Manabu Nakazawa; Taku Chikayama; Satsuki Ando; Kayoko Sugawara; Kazuhiro Hamaoka; Mie Inao; Masashi Oka; Satoshi Mochida
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-9-3
Journal Detail:
Title:  Hepatology research : the official journal of the Japan Society of Hepatology     Volume:  -     ISSN:  1386-6346     ISO Abbreviation:  Hepatol. Res.     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-9-16     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9711801     Medline TA:  Hepatol Res     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
This article is protected by copyright. All rights reserved.
Gastroenterology & Hepatology, Faculty of Medicine, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama 350-0495, Japan.
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