Ectopic Varices at Hepaticojejunostomy Site Presenting as Obscure Gastrointestinal Bleed with Portal Biliopathy

Abstract

RATIONALE Ectopic varix at the hepaticojejunostomy site is a rare finding. So symptomatic jejunal varices at this site are difficult to manage. PATIENT CONCERN A 37-year-old female presented with bleeding per rectum for 5 months with a history of hepaticojejunostomy done 6 years back for management of postcholecystectomy bile leak. DIAGNOSIS The endoscopic investigation could not identify the source of bleeding. When conservative management could not control her bleeding, she underwent DSA which showed haemorrhage from ectopic varices at the hepaticojejunostomy site. INTERVENTION The patient underwent embolization of ectopic varices to arrest bleeding OUTCOME After embolization, patient bleeding per rectum stopped and improvement in haemoglobin was noted within 3 days of the procedure. ABBREVIATIONS DSA: Digital subtraction angiography, SMA: Superior mesenteric artery, SMV: Superior mesenteric vein, HJ: Hepaticojejunostomy, AVSC: Adult variable stiffness colonoscope, SBE-Single balloon enteroscopy, DBE: Double balloon enteroscopy KEY WORDS Hepaticojejunostomy, Portal Biliopathy, Ectopic Varices, Variceal Embolization.