Thématique :
- Endoscopie/Imagerie
Originalité :
Solidité :
A confirmer
Doit faire évoluer notre pratique :
Dans certains cas
Nom du veilleur :
Docteur Michel GREFF
Coup de coeur :
World Journal of Gastrointestinal Pharmacology and Theapeutics
  2015 Nov 6;6(4):248-52  
  doi: 10.4292/wjgpt.v6.i4.248  
  Massive duodenal variceal bleed; complication of extra hepatic portal hypertension: Endoscopic management and literature review  
  Steevens C, Abdalla M, Kothari TH, Kaul V, Kothari S.  

Bleeding from duodenal varices is reported to be a catastrophic and often fatal event. Most of the cases in the literature involve patients with underlying cirrhosis. However, approximately one quarter of duodenal variceal bleeds is caused by extrahepatic portal hypertension and they represent a unique population given their lack of liver dysfunction. The authors present a case where a 61-year-old male with history of remote crush injury presented with bright red blood per rectum and was found to have bleeding from massive duodenal varices. Injection sclerotherapy with ethanolamine was performed and the patient experienced a favorable outcome with near resolution of his varices on endoscopic follow-up. The authors conclude that sclerotherapy is a reasonable first line therapy and review the literature surrounding the treatment of duodenal varices secondary to extrahepatic portal hypertension.

Question posée
Quelle est l’attitude au regard d’un saignement massif par varices duodénales en dehors de l’hypertension portale d’origine hépatique ?
Question posée
La sclérothérapie avec de l’éthanolamine est une voie thérapeutique au regard d’un case-report.

Il s’agit d’un cas clinique ouvrant probablement la voie à d’autres aspects thérapeutiques endoscopiques et à garder à l’esprit dans les situations exceptionnelles et d’urgence.