ethamolin and Rectal-Diseases

We present a patient with continuous melena, diagnosed as rectal varices bleeding. She had a history of esophageal varices, which was treated by endoscopic ligation therapy. Eight years after the treatment of esophageal varices, the continuous melena began. Colonoscopic examination showed that the melena was caused by rectal varices, which were so severe that they could not be treated by either endoscopic sclerotherapy or surgical devascularization. Taking into considering the overall risk of treating rectal varices, we chose the approach of double balloon-occluded embolotherapy (DBOE) with 5% ethanolamine oleate with iopamodol as a liquid embolic material. DBOE is one of the interventional radiology techniques (Morita et al., Acta Hepatol Jpn 1994;35:109-120), but in this case was a completely new and novel clinical procedure for rectal varices. After the DBOE therapy, the condition of rectal varices was markedly improved. Thus, DBOE might be a new tool for treating inoperable rectal varices.

Topics: Aged; Chemoembolization, Therapeutic; Embolization, Therapeutic; Female; Humans; Iopamidol; Oleic Acids; Rectal Diseases; Sclerosing Solutions; Tomography, X-Ray Computed; Varicose Veins

To report a sclerotherapy technique for rectal varices consisting of direct puncture of the superior rectal vein with a small-bore sheathed needle via the greater sciatic foramen without insertion of a sheath or catheter.. The subjects of this retrospective study were three consecutive patients who underwent embolization of rectal varices, two for rupture of rectal varices and one for hepatic encephalopathy and hyperammonemia. A 5% solution of ethanolamine oleate with iodinated contrast agent (5% EOI) was injected through puncture of the superior rectal vein and carried in the blood flow, after which n-butyl cyanoacrylate mixed with lipiodol (NBCA-Lip) was immediately injected to stop the blood flow.. The 5% EOI and NBCA-Lip were successfully injected in all three patients. There was no movement of NBCA-Lip on plain radiographs or computed tomography (CT) immediately after injection, and the 5% EOI remained within the rectal varices. The mean procedure time was 53 min (42-60 min). On contrast-enhanced CT 1 month after the procedure, there was no contrast enhancement of the rectal varices that had been seen on preoperative CT in any of the three patients, confirming that the rectal varices had disappeared.. Sclerotherapy for rectal varices using an approach for puncture of the superior rectal vein with a small-bore sheathed needle via the greater sciatic foramen was technically feasible and clinically effective.

Topics: Aged; Contrast Media; Esophageal and Gastric Varices; Female; Humans; Needles; Oleic Acids; Punctures; Radiography; Rectal Diseases; Rectum; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome

A 56-year-old male with alcohol-induced liver cirrhosis developed rectal varices. He had a prior history of treatment for esophageal varices with endoscopic variceal ligation. Despite the repeated treatment for rectal varices with endoscopic variceal ligation, endoscopic injection sclerotherapy, and surgery, the bleeding from the rectal varices could not be controlled. Multidetector-row computed tomography and 3D-angiography revealed the hemodynamic profile of the rectal varices. We next approached the rectal varices through the umbilical vein on the abdominal wall, and successfully embolized the varices continuing from the inferior mesenteric vein using coils and a 5% solution of ethanolamine oleate with iopamidol.

Topics: Endoscopy; Gastrointestinal Hemorrhage; Humans; Injections, Intralesional; Male; Middle Aged; Multidetector Computed Tomography; Oleic Acids; Rectal Diseases; Rectum; Sclerosing Solutions; Sclerotherapy; Umbilical Veins; Varicose Veins