Ectopic Varices

Bleeding from nongastroesophageal sites varies from 1.6 to 5% in the large reported series. The common ectopic sites, usually seen in association with esophageal varices, are duodenum, colon, anorectum, and enterostomy. Rarely these varices may be localized, especially in the colon, and result from superior or inferior vein thrombosis, tumor infiltration, adhesions, or congenital malformation. The management of the bleeding depends on the site of bleeding, the severity of liver disease, and the local expertise. Because there are no controlled studies, it is difficult to recommend any special strategy. Shunt surgery may be the best line of management for bleeding varices in the duodenum, jejunum, ileum, and enterostomy. If portal vein is patent and the expertise for TIPS is readily available, TIPS should be considered as the first line of management before other forms of shunt surgery. Anecdotal reports suggest that duodenal varices and ileostomy varices can be managed successfully by sclerotherapy or feeding vessel embolization, but one has to consider carefully the postsclerotherapy complications, such as duodenal perforation and stoma dysfunction, and the high recurrence rate after embolization. Tissue adhesives may be used in selected cases. Colonic varices are usually localized and can be managed by local resection. When colonic varices are seen in association with esophageal varices, TIPS may be a safer alternative. Anorectal varices can be safely treated with sclerotherapy or by underrunning with an absorbable suture.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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