EXTREME HYPERBILIRUBINEMIA INDUCED BY ENDOSCOPIC INJECTION SCLEROTHERAPY IN A PATIENT WITH ESOPHAGEAL-VARICES AND THALASSEMIA - REPORT OF ACASE

We describe herein the case of a 57-year-old man with thalassemia who developed acute liver failure after undergoing endoscopic injection sc lerotherapy (EIS) to control hemorrhage from a ruptured esophageal var ix. The patient, who had been comfirmed as having liver cirrhosis due to chronic hepatitis C with thalassemia in 1989, was admitted to our d epartment to undergo EIS for esophageal varices, at which time his ser um total bilirubin level was 5.5 mg/dl. As a small amount of hematemes is occurred just after a percutaneous transhepatic portography was per formed, emergency EIS was carried out, following which the serum total bilirubin level markedly increased, mainly with a direct fraction, un til it reached 70 mg/dl. The patient eventually died from acute liver failure with extreme hyperbilirubinemia on the 27th day after experien cing hematemesis despite all treatment. This unfortunate case demonstr ates that sclerotherapy could be an inappropriate method of treatment for patients with hemolytic disease.