MASSIVE HEMORRHAGE FROM JEJUNAL VARIX

A 21-year-old male presented with melaena and signs of hemorrhagic sho ck. In the following days several episodes of hematochezia occurred re quiring the transfusion of nine units of blood. Findings at gastroscop y were normal, at colonoscopy fresh blood was noted from the ileocecal valve. Angiography per formed in a bleeding-free interval showed no a bnormalities. At repeat angiography, bleeding (from a left lateral bra nch of the superior mesenteric artery) was provoked by instillation of plasminogen activator. Subsequently, hemostasis was achieved by super selective embolization using coils. At operation one week later, a pol ypoid tumor of 1 cm diameter was resected along with a 4 cm segment of adjacent jejunum (40 cm distal to the ligament of Treitz). Histologic ally, a jejunal varix with superficial ulceration was diagnosed.