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Bleeding gastric varices and antiphospholipid syndrome

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 156–159 (2005)Cite this article

Abstract

Background A 35-year-old woman with a past history of antiphospholipid syndrome and near-fatal vascular thrombosis was transferred to Glasgow Royal Infirmary, UK, for investigation of 'obscure' gastrointestinal bleeding in the context of long-term oral anticoagulation therapy. Initial endoscopic examination revealed isolated gastric varices with stigmata of recent hemorrhage. She had no prior history of liver disease or portal hypertension. Investigations to ascertain the cause of her varices were performed.

Investigations CT venography, endoscopic ultrasound and transjugular liver biopsy.

Diagnosis Nodular regenerative hyperplasia of the liver leading to gastric varices.

Management Endoscopic histacryl tissue-glue injection followed by transjugular intrahepatic portosystemic shunt and long-term oral anticoagulation therapy.

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Figure 1: Endoscopic image of gastric varices.
Figure 2: Liver biopsy stained with reticulin.

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Acknowledgements

Written consent for publication was obtained from the patient.

Author information

Authors and Affiliations

  1. Specialist Registrar in Gastroenterology Glasgow Royal Infirmary, UK

    Daniel R Gaya

  2. Consultant Gastroenterologists at Glasgow Royal Infirmary, UK

    Adrian J Stanley & Allan J Morris

  3. Consultant Pathologist at Glasgow Royal Infirmary and Clinician Scientist at Cancer Research UK, Beatson Laboratories, Glasgow, UK

    Karin A Oien

Authors
  1. Daniel R Gaya
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  2. Karin A Oien
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  3. Adrian J Stanley
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  4. Allan J Morris
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Corresponding author

Correspondence to Daniel R Gaya.

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Competing interests

The authors declare no competing financial interests.

Glossary

LIVEDO RETICULARIS

A net-like cyanotic rash that most often appears on the limbs. It can be an idiopathic phenomenon or be secondary to thrombosis or vasculitis in the underlying blood vessels

CARDIOLIPIN ANTIBOdY

An antibody against phospholipids in the cell membrane; associated with recurrent thromboses and unexplained pregnancy loss

HEPARIN

A glycosaminoglycan anticoagulant that binds to and potentiates the action of antithrombin, an endogenous anticoagulant

CT VENOGRAPHY

A CT scan that uses intravenous contrast with image acquisition in the (porto-) venous phase

HISTOACRYL TISSUE GLUE

A form of tissue glue, the active compound being n-butyl-2-cyanoacrylate, which polymerises into a solid resin on contact with liquid (blood)

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Gaya, D., Oien, K., Stanley, A. et al. Bleeding gastric varices and antiphospholipid syndrome. Nat Rev Gastroenterol Hepatol 2, 156–159 (2005). https://doi.org/10.1038/ncpgasthep0110

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  • DOI: https://doi.org/10.1038/ncpgasthep0110

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