Massive bleeding from ascending variceal bleeding treated with embolization of var icose vein
의약학 > 내과학
( Hyoung Jin Chang ) , ( Sang Bum Kang )
대한내과학회 추계학술발표논문집 2011년, 제2011권 제1호, 62(총1페이지)
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    A 38-year-old woman visited an out-patient department due to hematochezia, epigastric pain for 15days and facial edema. She had histories of long standing alcohol comsumption and liver cirrhosis for 6yrs. Her blood pressure was 80/60 mmHg and pulse rate was 68/min. She was classified as having liver cirrhosis Child-Pugh class C at this point. Colonoscopic examination showed clear terminal ileal mucosa and fresh color blood at whole colon without an active bleeding site. we tried abdominal angiography for finding of bleeding focus but no evidence of discernible bleeding focus on the arteriograms. One day later she had continuous hematochezia accompanied by hypotension. Esophagogastroduodenoscopy and colonoscopy was performed again. Esophagogastroduodenoscopy revealed no active bleeding sign. Colonoscopic finding was massive fresh blood and clot at whole colon. We doubted variceal bleeding of ascending colon and retried abdominal angiogramsAt angiograms definite bleeding focus was not found. Next day she developed massive hematochezia. We had decided to take abdominal 3D CT and found portocaval shunt and marked varicose vein at beside of right colon. She was done embolizaion for retrograde varicose vein through IVC approach. Post embolization varicose vein was not complited obliteration, but blood flow was decresed. Although the patient?s vital signs were stable and there was no further bleeding after the embolization of retrograde varicose vein, her condition deteriorated. The patient died of hepatic failure and renal failure on 4th day after embolization.
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