Association of transjugular intrahepatic portosystemic shunt with embolization in the treatment of bleeding duodenal varix refractory to sclerotherapy

Background: Bleeding from duodenal varices are often severe (mortality as h igh as 40%), and more difficult to sclerose than esophageal varices, We rep ort a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement an d varix embolization, via the same transjugular intrahepatic route. Methods : A 40-year-old Black male underwent emergency TIPS and duodenal varix embo lization after failure of endoscopic sclerotherapy, The portosystemic press ure gradient droped from 16 to 9 mm Hg following TIPS. At 5 months from TIP S, the patient is well, with a patent shunt at Doppler ultrasound. Conclusi on: The present report of successful control of duodenal varix, actively bl eeding and refractory to sclerotherapy, by means of combined TIPS and embol ization, supports the role of TIPS and suggests that its association to emb olization can be valuably considered in the difficult setting of portal hyp ertension with bleeding duodenal varices. Copyright (C) 2000 S. Karger AG, Basel.