Summary
A 21-year-old man was hospitalized with repeated bleeding from the gastrointestinal tract, the cause of which could not be detected by gastroscopy, colonoscopy or arteriography. After the third surgical intervention he died of uncontrollable bleeding. At autopsy, marked and partly ulcerated duodenal varices were found to be the cause of the bleeding. They were part of a collateral circulation that had developed from chronic obstruction of the inferior vena cava, where thrombosis had arisen in association with neonatal renal vein thrombosis. There was consecutive renal infarction which had required a left nephrectomy on the 2nd day after birth.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alberti W (1931) Über den röntgenologischen Nachweis von Varizen im Bulbus duodeni. Fortschr Röntgenstr 43:60–65
Amin R, Alexis R, Korzis J (1985) Fatal ruptured duodenal varix: a case report and review of literature. Am J Gastroenterol 80:13–18
Chatel A, Bigot JM, Barret F, Hélénon C (1979) Veines spermatiques, voies de suppléance. J Radiol 60:121–127
Feriozi D, Rice EC, Burdick WF, Troendle FJ (1951) Thrombosis of the inferior vena cava and renal veins with hemorrhagic renal infraction in infancy. J Pediatr 38:235–241
Ferris EJ, Vittimberga FJ, Byrne JJ, Nasbeth DC, Shapiro JH (1967) The inferior vena cava after ligation and plication: a study of collateral routes. Radiology 89:1–10
Fielding GA, Masel J, Leditschke JF (1986) Spontaneous neonatal renal vein thrombosis. Aust NZ J Surg 56:485–488
Fletcher EW, Thomas ML (1968) Chronic post-thrombotic obstruction of the inferior vena cava investigated by cavography. Am J Roentgenol 102:363–371
Friedman A, Sprayregen S, Appelman R (1978) Partial obstruction of the ureter by venous collaterals in inferior vena cava thrombosis. Angiology 29:925–928
Greenspan A, Bryk D (1973) Duodenal varices secondary to inferior vena cava obstruction. Am J Dig Dis 18:983–986
Gushurst TP, Lesesne HR (1984) Isolated duodenal varix: an unusual cause of gastrointestinal hemorrhage. South Med J 77:15–18
Hach W (1971) Kollateralkreislauf beim Verschluβ der V. cava inferior und der Beckenvenen. Med Klin 66:1574–1578
Itzchak Y, Glickman MG (1977) Duodenal varices in extrahepatic portal obstruction. Radiology 124:619–624
Kendall B (1965) Collateral flow to the portal system in obstruction of the iliac veins and inferior vena cava. Br J Radiol 38:789–801
Khouqeer F, Morrow C, Jordan P (1987) Duodenal varices as a cause of massive upper gastrointestinal bleeding. Surgery 102:548–552
Mignon G, Flora G (1974) Seltener Umgehungskreislauf bei Zustand nach Thrombose der Vena cava inferior und Becken-Beinvenenthrombose links. ROFO 120:620–621
Pollak VE, Weiss MA (1989) Renal vein thrombosis. In: Tisher CC, Brenner BM (eds) Renal pathology with clinical and functional correlations, vol II. Lippincott, Philadelphia, pp 1114–1130
Preuβ EG, Hänsgen K (1981) Vena-cava-inferior-Thrombose. — Ein ätiologischer und klinischer Beitrag. Z Gesamte Inn Med 36:712–716
Reis HE, Moschinski D, Borchard F (1982) Isolierte Dünndarmvarikosis ohne Pfortaderblock als Ursache einer massiven oberen Gastrointestinalblutung. Leber Magen Darm 12:23–31
Rösch W (1981) Duodenalvarizen. Schweiz Rundsch Med Prax 70:2098–2099
Singson RD, Dee G, Quader MA (1984) Case report 265. Scalloping and destruction of pedicles of lumbar vertebral bodies on the right side secondary to venous collaterals, associated with thrombosis of the inferior vena cava. Skeletal Radiol 11:293–295
Sörensen R, Taenzer V (1973) Die venöse Kollateralzirkulation beim tumorösen Verschluβ der Vena cava caudalis mit Ölembolisation der Leber nach Lymphographie. ROFO 119:327–330
Swart B (1968) Zur Entwicklungssystematik von Ösophagus-, Magen- und Duodenalvarizen bei portaler Hypertension. Fortschr Röntgenstr 108:184–197
Ullrich F, Becker H, Hissen W (1981) Isolierte Varicosis des Bulbus duodeni bei portaler Hypertension. Chirurg 52:540–541
Vogel J, Häberle HJ, Freidrich JM, Schumacher KA, Bargon G (1991) Kongenitale und erworbene Anomalien der Vena cava inferior. ROFO 154:180–186
Wheeler HB, Warren R (1957) Duodenal varices due to protal hypertension from arteriovenous aneurysm. Report of a case. Ann Surg 146:423–424
Zückmantel WR, Endert G (1988) Untersuchungen über den systemoportalen Shunt bei Beckenvenenthrombose und Vena-cava-inferior-Syndrom. Radiol Diagn (Berl) 29:635–640
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Zhou, H., Janssen, D., Günther, E. et al. Fatal bleeding from duodenal varices as a late complication of neonatal thrombosis of the inferior vena cava. Vichows Archiv A Pathol Anat 420, 367–370 (1992). https://doi.org/10.1007/BF01600217
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01600217