PMC2830976_01
Esophagogastroscopy on admission. (a) Endoscopic picture shows esophagogastric varices (Li F2 Cb RC (+), Lg-cf F1 RC (-). (b) White thrombus was observed on the middle of the esophageal varices. (c) The first session of variceal ligation with one rubber band was carried out successfully. (d) Endoscopic picture shows the banded varices 5 days after the first variceal ligation.
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F1
An emergency endoscopy showed esophagogastric varices (Li F2 Cb RC (+), Lg-cf F1 RC (-)) (Figure 1).
Abdominal computed tomography. Dilated splenic vein with massive splenomegaly was demonstrated by a computed tomography scan.
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F2
Another endoscopic ligation was performed for the remaining varices 41 days after her admission (Figure 2).
Endoscopic findings before and after additional endoscopic therapy for the remaining varices. (a) Endoscopic picture shows the remaining esophagogastric varices 41 days after the patient's admission (Ls F3 Cb RC (+), Lg-c F1 Cw RC (-); a variceal ligation with seven rubber bands was carried out. (b) Resolving esophageal varices (Lm F1 Cb RC (-), Lg (-) were observed 1 week after the ligation. (c) Markedly improved endoscopic findings 4 months after the variceal ligation treatment. The varices were completely eradicated.
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F3
After the chemotherapy, her splenomegaly improved without the recurrence of esophagogastric varices (Figure 3 and Figure 4).
Clinical course. Extramedullary hematopoiesis has been treated by chemotherapy using hydroxycarbamide, prednisolone (PSL) and melphalan (Alkelan, L-PAM). After the chemotherapy, the splenomegaly improved without the recurrence of esophagogastric varices. Vertical axis expresses; WBC (/mul), Hb (g/dl), Plt (x10/mul).
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F4
After the chemotherapy, her splenomegaly improved without the recurrence of esophagogastric varices (Figure 3 and Figure 4).