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KMID : 1130320130560110500
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Korean Journal of Pediatrics
2013 Volume.56 No. 11 p.500 ~ p.504
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Stroke after percutaneous transhepatic variceal obliteration of esophageal varix in Caroli syndrome
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Lee Yoo-Min
Lee Yoon
Choe Yon-Ho
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Abstract
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Here we present the case of an 11-year-old female patient diagnosed with Caroli syndrome, who
had refractory esophageal varices. The patient had a history of recurrent bleeding from esophageal
varices, which was treated with endoscopic variceal ligation thrice over a period of 2 years. However,
the bleeding was not controlled. When the patient finally visited the Emergency Department, the
hemoglobin level was 4.4 g/dL. Transhepatic intrajugular portosystemic shunt was unsuccessful.
Subsequently, the patient underwent percutaneous transhepatic variceal obliteration. Twenty hours
after this procedure, the patient complained of aphasia, dizziness, headache, and general weakness.
Six hours later, the patient became drowsy and unresponsive to painful stimuli. Lipiodol particles used
to embolize the coronary and posterior gastric veins might have passed into the systemic arterial
circulation, and they were found to be lodged in the brain, kidney, lung, and stomach. There was no
abnormality of the portal vein on portal venography, and blood flow to the azygos vein through the
paravertebral and hemiazygos systems was found to drain to the systemic circulation on coronary
venography. Contrast echocardiography showed no pulmonary arteriovenous fistula. Symptoms
improved with conservative management, and the esophageal varices were found to have improved on
esophagogastroduodenoscopy.
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KEYWORD
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Percutaneous transhepatic variceal obliteration, Systemic, Embolization, Esophageal varix, Caroli syndrome
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