Ligation of a Bleeding Colonic Varix using an Upper Gastrointestinal Endoscope UCTN

References

1 Misra SP, Dwivedi M, Misra V. Prevalence and factors influencing , ano- rectal varices and colopathy in patients with portal . Endoscopy 1996; 29: 340–345 Un 2 Misra SP, Misra V, Dwivedi M. Effect of usual esophageal variceal sclerotherapy on he- morrhoids, anorectal varices and portal co-

lopathy. Endoscopy 1999; 31: 741–744 Cases 3 Misra SP, Misra V, Dwivedi M. Effect of esophageal variceal ligation on hemor-

rhoids, anorectal varices and portal colopa- and thy. Endoscopy 2002; 34: 195 –198 4 Waxman JS, Tarkin N, Pradyuman D et al. T Fatal hemorrhage from rectal varices: report echni of two cases. Dis Colon 1984; 27:

Figure 2 The colonic varix has been banded 749–745 cal Figure 1 The bleeding colonic varix has been and hemostasis achieved. 5 Uno Y, Munakata A, Ishiguro A et al. Endo- targeted through the ligating device mount- scopic ligation for bleeding rectal varices in Not ed on an upper gastrointestinal endoscope. a child with primary extrahepatic portal hy- pertension. Endoscopy 1998; 30: S107– es S108 Although anorectal and colonic varices followed by a continuous infusion. With are not uncommon, bleeding from these the patient hemodynamically stable, co- Corresponding Author varices is extremely rare [1 –3]. However, lonoscopy was carried out, and a severely when they do bleed, the bleeding may be bleeding varix was observed in the des- S. P. Misra M.D. massive and occasionally fatal [4]. Endo- cending colon, close to the splenic flexure. 657 Dept. of scopic variceal ligation (EVL) is a well-es- During withdrawal of the colonoscope, Motilal Nehru Medical College tablished procedure for emergency as blood and clots were sucked out. At the Allahabad 211001 well as elective ligation of esophageal same time, an assistant loaded the multi- India varices. Although there have been a few ple-band ligation device on a forward- Fax: +91-532-2611420 reports of variceal ligation to arrest rectal viewing upper gastrointestinal endo- E-mail: [email protected] variceal bleeding [5], there have been no scope. Three of the O-rings were fired out- reports of its use in bleeding colonic vari- side the patient. As soon as the colono- ces, so far as we are aware. scope was withdrawn, the upper gastro- intestinal endoscope with the loaded bar- A 32-year-old man was admitted to hos- rel containing three O-rings was ad- pital for massive lower gastrointestinal vanced from the rectum as far as the site bleeding. He was known to have of bleeding. The bleeding varix was iden- of the due to B and had un- tified (Figure 1) and sucked into the barrel This document was downloaded for personal use only. Unauthorized distribution is strictly prohibited. dergone endoscopic variceal ligation of the ligation device, and the O-rings (EVL) for bleeding from esophageal vari- were fired. The very first O-ring was suc- ces. Repeated EVL procedures had led to cessful in ligating the varix, and the obliteration of the 9 bleeding stopped. Another O-ring was ap- months prior to this admission. He later plied over the varix (Figure 2), and the developed bleeding from , procedure was concluded. which was effectively controlled, and the gastric varices were obliterated after glue Endoscopy_UCTN_Code_TTT_1AQ_2AZ injection. S. P. Misra, M. Dwivedi Intravenous fluids were administered and Dept. of Gastroenterology, Motilal Nehru four units of whole blood were trans- Medical College, Allahabad, India. fused. A bolus of intravenous somatosta- Published online 27 April 2006 tin was administered in the other arm, DOI: 10.1055/s-2006-925189

Misra SP et al. Banding of a Bleeding Colonic Varix · Endoscopy 2006; 38: 657