{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T02:57:33Z","timestamp":1764212253676,"version":"3.41.2"},"reference-count":11,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T00:00:00Z","timestamp":1650412800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Varices are a common cause of gastrointestinal (GI) bleed. When ectopic, there is often a delay in diagnosis as it is difficult to localize these varices. Ectopic small bowel varices usually arise from portal hypertension, which commonly develops in the setting of cirrhosis. This case presents a much rarer cause of bleeding ectopic varices with portal hypertension secondary to chronic superior mesenteric vein (SMV) thrombosis that developed after an episode of hemorrhagic pancreatitis. An 81\u2010year\u2010old man with a past medical history of a recent GI bleeds secondary to an arteriovenous malformation presented to the hospital with continued melena after a recent admission at another hospital for the same symptom. Upper endoscopy and colonoscopy showed no evidence of active bleeding. Subsequently computed tomography angiography (CTA) showed bleeding from collaterals in the third part of the duodenum, consistent with ectopic varices. The CTA also showed SMV thrombosis. The patient underwent an ultrasound\u2010guided transhepatic venogram with coiling and sclerosant embolization of SMV varices and distal SMV balloon angioplasty. Capsule endoscopy after showed no evidence of further bleeding. The patient was discharged 72\u00a0h after the intervention with stabilized hemoglobin and resolved melena. Ectopic varices should be on the differential diagnosis for patients presenting with a GI bleed that remains nonlocalized after endoscopy and colonoscopy. EGD or colonoscopy is the first\u2010line intervention for the treatment of bleeding ectopic varices. If unreachable by these means, percutaneous coil embolization is an alternative way to stabilize the patient. As no general management guidelines exist, treatment of bleeding ectopic varices should continue to be case\u2010dependent and involve a multidisciplinary team.<\/jats:p>","DOI":"10.1002\/ccr3.5731","type":"journal-article","created":{"date-parts":[[2022,4,20]],"date-time":"2022-04-20T10:55:09Z","timestamp":1650452109000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ectopic variceal bleeding from chronic superior mesenteric vein thrombosis after hemorrhagic pancreatitis"],"prefix":"10.1002","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1026-8778","authenticated-orcid":false,"given":"Kathryn","family":"Flynn","sequence":"first","affiliation":[{"name":"Internal Medicine Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin","family":"Chung","sequence":"additional","affiliation":[{"name":"Pulmonary and Critical Care Medicine Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Brooke","sequence":"additional","affiliation":[{"name":"Internal Medicine Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Keung","sequence":"additional","affiliation":[{"name":"Interventional Radiology Walter Reed National Military Medical Center  Bethesda Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,4,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9074-1"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2008.03719.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/1358863X10379673"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1477-2574.2011.00392.x"},{"key":"e_1_2_9_6_1","first-page":"281","article-title":"A case of isolated duodenal varices secondary to chronic pancreatitis with review of literature","volume":"3","author":"Bommana V","year":"2010","journal-title":"Gastroenterology Res"},{"key":"e_1_2_9_7_1","first-page":"922","article-title":"A study of aetiology of portal hypertension in adults (including the elderly) at a tertiary centre in southern India","volume":"137","author":"Goel A","year":"2013","journal-title":"Indian J Med Res"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2013.09.068"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.4292\/wjgpt.v10.i1.1"},{"key":"e_1_2_9_10_1","first-page":"167","article-title":"Ectopic varices","volume":"1","author":"Sarin SK","year":"2012","journal-title":"Clin Liver Dis (Hoboken)"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.4103\/ijri.IJRI_21_19"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tgie.2017.03.007"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.5731","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.5731","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.5731","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T21:56:07Z","timestamp":1692827767000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.5731"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4]]},"references-count":11,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2022,4]]}},"alternative-id":["10.1002\/ccr3.5731"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.5731","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"type":"print","value":"2050-0904"},{"type":"electronic","value":"2050-0904"}],"subject":[],"published":{"date-parts":[[2022,4]]},"assertion":[{"value":"2021-11-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-03-07","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-04-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e05731"}}