内視鏡的治療抵抗性のび慢性胃前庭部毛細血管拡張症に対し胃切除術を行い吻合部静脈瘤破裂を伴った１例

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  • A CASE OF RUPTURED ANASTOMOTIC VARICES AFTER GASTRECTOMY FOR DIFFUSE ANTRAL VASCULAR ECTASIA (DAVE) THAT WOULD NOT BE TREATED ON ENDOSCOPY

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Most cases of DAVE (GAVE) are successfully treated with endoscopy, especially those requiring coagulation. A 65-year-old woman was referred to our hospital due to anemia . On upper GI endoscopy, DAVE and with liver cirrhosis caused by the hepatitis B virus were identified. Endoscopic treatment for hemostasis was done 14 times . However, the DAVE recurred frequently. The patient required blood transfusions and was readmitted several times .Therefore, a gastrectomy was done. However, an anastomotic gastric varices developed and ruptured 8 days after surgery. EVL combined with the aethoxysklerol (AS) fibrosing method was successfully used to deal with the varices. None of the previously reported GAVE case, that had surgery developed ruptured gastric varices in the early stage after gastrectomy . It must be kept in mind that a gastrectomy in a patient with portal hypertension, can result in ectopic varices. Four years after surgery, the patient is alive and has had no recurrences of GAVE or anastomotic varices.

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