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• W3033659871 abstract "A 36-year-old man with a past medical history significant for antiphospholipid syndrome complicated by a cerebrovascular event requiring indefinite coumadin anticoagulation, presented for epigastric pain and vomiting of a few days duration. His blood work was unremarkable except for an elevated lipase (150) without meeting the acute pancreatitis criteria. An ultrasound of the abdomen was negative for cholelithiasis and unremarkable bile ducts. However, a CT showed edema around the portal confluence. He was admitted for ideopathic pancreatitis. A week later, a repeat CT showed a hemorrhagic collection at the superior mesenteric vein (SMV). An angiogram by interventional radiology (IR) ruled out an arterial source of bleeding, however the gastroduodenal artery was embolized empirically. A few days later a third CT revealed an increase in size of the collection, severe SMV stenosis and the emergence of abdominal- notably gastric- varices. The bleeding had stabilized however the emerging findings on CT raised a concern for bleeding from the formed varices in light of concomitant use of anticoagulation and a concern of thrombus formation in the portal system due to a compromise in the portal venous flow exerted by the vascular configuration. A multidisciplinary approach was planned with IR to drain the bloody configuration endoscopically. The portal venous system was accessed percutaneously. The inferior mesenteric vein IMV was eventually accessed however the SMV was completely occluded. Through a collateral between the IMV and SMV, the SMV was accessed retrogradely. The catheter was then advanced to the splenic vein. With this setup, the portal vasculature was within IR’s reach for intervention in the occurrence of bleeding. Endoscopic ultrasonography (EUS) revealed a 4.6 cm heterogenous collection suggesting different consistencies of blood. A 19 gage needle was introduced into the collection through a trans gastric access. A guide wire was then introduced and with wire guidance a 10 x10 mm lumen apposing metallic stent was deployed between the configuration and the stomach. Blood drained spontaneously to the gastric lumen. Using a CRE balloon dilation to 12 mm was performed. Further evacuation of clots was performed to a point where the stenosis in the SMV decreased to allow anterograde access of the IR catheter. At 2 and 6 months follow up, the patient the patient remained asymptomatic on full anticoagulation. Our patient had complicated autoimmune disease predisposing him to clot formation. The etiology of his SMV injury is unclear. Possible etiologies include ideopathic pancreatitis or autoimmune vasculitis. Regardless of the etiology, prompt evacuation of the bleed was crucial. IR / GI coordination made this procedure safe and possible." @default.
• W3033659871 created "2020-06-12" @default.
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• W3033659871 date "2020-06-01" @default.
• W3033659871 modified "2023-09-25" @default.
• W3033659871 title "980 ENDOSCOPIC ULTRASOUND GUIDED DRAINAGE OF A VASCULAR CONFIGURATION: WHEN CAUGHT BETWEEN A ROCK AND A HARD PLACE" @default.
• W3033659871 doi "https://doi.org/10.1016/j.gie.2020.03.641" @default.
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