Gastroenterology

Gastroenterology

Volume 115, Issue 1, July 1998, Pages 167-172
Gastroenterology

Case Reports
Transjugular intrahepatic portosystemic shunt for bleeding angiodysplasia-like lesions in portal-hypertensive colopathy

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Abstract

Portal-hypertensive colopathy has attracted interest in recent years because such lesions can cause life-threatening hemorrhage. In contrast to upper gastrointestinal bleeding from varices, there is no established therapy for bleeding from angiodysplasia-like lesions. This case report describes the first successful use of transjugular intrahepatic portosystemic shunt (TIPS) for long-term control of bleeding from angiodysplasia-like colonic lesions in a patient with cirrhosis caused by chronic hepatitis B infection. During an 18-month course after TIPS, angiodysplasia-like lesions disappeared without any further evidence of recurrent hematochezia. TIPS may be helpful as second-line treatment in patients with recurrent portal-hypertensive bleeding from colonic angiodysplasia-like lesions who do not tolerate or are unresponsive to treatment with β-adrenergic blockers.

GASTROENTEROLOGY 1998;115:167-172

Section snippets

Case report

A 75-year-old woman was admitted to our department for further evaluation of recurrent anorectal bleeding.

The patient had been asymptomatic until 11 months earlier when she experienced repeated upper GI bleeding (five distinct episodes) that required esophageal sclerotherapy. She was treated with a nonselective β-blocker (propranolol, 25 mg twice a day) to prevent further upper GI bleeding. A diagnosis of liver cirrhosis caused by chronic active hepatitis B was made. A history of infection

Discussion

Patients with portal hypertension may bleed from variceal portosystemic collaterals or specific nonvariceal lesions.

Varices can occur along the entire GI tract. Most commonly they are found as esophageal or gastric varices frequently causing upper GI bleeding.18 Besides the description of portal-hypertensive gastropathy, few data are available on portal-hypertensive intestinal vasculopathy involving small bowel (enteropathy) and the colon (colopathy).12, 19, 20, 21, 22, 23 Although PHC is

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    Address requests for reprints to: Wolfgang E. Fleig, M.D., First Department of Medicine, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06097 Halle/Saale, Germany. Fax: (49) 345-5572253.

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