A SERENDIPITOUS DETOUR: DIRECT PERCUTANEOUS EMBOLIZATION OF ECTOPIC VARIX

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Variceal bleeding can be a devastating complication of cirrhosis; minority varices develop at sites apart from the esophagus or stomach. We present case an ectopic variceal complicated by hemorrhagic shock, managed direct percutaneous embolization small bowel varix in ventral hernia. CASE PRESENTATION: A 47-year-old woman with history decompensated alcoholic cirrhosis presented sudden onset profuse bright red bloody output per rectum. She was hypotensive, tachycardic, and had Labwork notable for anemia (hemoglobin 2.9 mg/dL). Computed tomography (CT) angiography abdomen pelvis did not reveal source hemorrhage, but show large hernia containing without signs strangulation. treated pantoprazole, octreotide, transfusions packed cells fresh frozen plasma, vasopressor support, mechanical ventilation. Esophagoduodenoscopy revealed mild non-bleeding esophageal varices. Colonoscopy few oozing portal colopathy cautery. Given presence chronic vein thrombus extensive collaterals, there concern varix. On review initial imaging, dilated noted to track along loop intestine underwent puncture under ultrasound guidance, followed coiling gel foaming superior mesenteric venous system. Following procedure, patient developed gastrointestinal necessitating massive transfusion. Repeat esophagoduodenoscopy demonstrated grade II active banding. Continued hemorrhage led hemodynamic collapse, patient's demise. DISCUSSION: Small challenging diagnose; they may transjugular intrahepatic porto-systemic shunt (TIPS), enteroscopy, embolization, surgery. Percutaneous chosen as treatment modality our due profound instability emergent need homeostasis. This is usually carried out via transjugular, transfemoral, transhepatic approach. The serendipitous portion on afforded unconventional approach employed here. There have only been cases similar based literature review. Embolization successfully, other varices, perhaps increased pressure CONCLUSIONS: Direct critical care setting provided favorable anatomy present. REFERENCE #1: Lim L, Lee Y, Tan et al. paraumbilical successful jejunal World J Gastroenterol. 2009 Aug 14; 15(30): 3823–3826. DISCLOSURES: No relevant relationships Ajinkya Buradkar, source=Web Response no disclosure file William Haas; Danish Haque, Pius Ochieng, Nikul Patel; Arooj Quadir, NISHANT SHARMA,