Push enteroscopy for recurrent gastrointestinal hemorrhage due to jejunal anastomotic varices: a case report and review of the literature.

Small-bowel anastomotic and adhesion-related varices can form within adhesions in the setting of mesenteric venous hypertension, arising from either mesenteric venous obstruction or portal hypertension. In evaluating gastrointestinal bleeding in patients who have had previous abdominal surgery and mesenteric venous hypertension, small-bowel anastomotic varices and adhesion-related varices should be considered. For patients with recurrent, severe melena or hematochezia, we recommend that the initial diagnostic work-up should include push enteroscopy in patients with previous small-bowel surgery. Retrograde ileoscopy should also be considered these patients to look for distal small-bowel varices. Potentially, such small-bowel varices can be identified by wireless capsule endoscopy. We report a case of recurrent gastrointestinal bleeding caused by jejunal anastomotic varices which were secondary to superior mesenteric vein occlusion following an abdominal gunshot wound. Although the treatment of segmental varices has been surgical resection, for patients with overt systemic portal hypertension, a transjugular intrahepatic portal-systemic shunt or a decompressive shunting procedure are recommended.