Video Capsule Endoscopy - Varices, Small Intestine

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abstract

This 27 year old male was referred for VCE after negative EGD and colonoscopy was performed for evaluation of recurrent severe gastrointestinal bleeding requiring multiple transfusions. He had undergone extensive surgery following a gunshot wound 18 month previously which required repair of small bo...

wel and vascular injuries as well as IVC filter placement. The sequence of VCE images shown here demonstrates multiple areas of bluish nodules among the small bowel folds. These discolored areas represent small bowel varices and are the likely source of this man's recurrent bleeding. Small bowel varices are uncommon but may be encountered in the setting of altered abdominal vascular anatomy with or without prior small bowel surgery. Evidence of collateral flow is seen on the abdominal CT images which demonstrate varices both in the intrabdominal region as well as in the abdominal wall. Most typically small bowel varices are seen in patients with portal hypertension who have undergone bowel surgery resulting in a small bowel anastomosis or ostomy. In certain circumstances, a TIPS procedure and /or beta blockers can be used to lower portal pressures. Surgical approaches should be aimed at shunting rather than resection, since recurrence is common if the portal pressure elevation is not addressed.