PMC5960554_01
Hemobilia from a ruptured periampullary varix seen during an endoscopic retrograde cholangiopancreatography (ERCP).
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fig1
During the procedure, she developed active hemobilia (Figure 1) from a newly discovered periampullary varix (Figure 2).
A duodenal varix (blue arrow) seen in the periampullary region on retroflexion during endoscopic retrograde cholangiopancreatography (ERCP).
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fig2
During the procedure, she developed active hemobilia (Figure 1) from a newly discovered periampullary varix (Figure 2).
Intraoperative photo demonstrating the mesocaval bypass. An 8 mm ringed polytetrafluoroethylene (PTFE) graft was used to shunt blood flow from the proximal superior mesenteric vein (SMV) to the infrarenal IVC.
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fig3
Due to ongoing bleeding that required activation of a massive transfusion protocol, an exploratory laparotomy was performed with emergent mesocaval shunt placement (Figures 3 and 4).
Coronal view on computed tomography showing the mesocaval shunt (yellow arrow) originating from the SMV and inserting into the infrarenal IVC.
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fig4
Due to ongoing bleeding that required activation of a massive transfusion protocol, an exploratory laparotomy was performed with emergent mesocaval shunt placement (Figures 3 and 4).