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Case Report

Viswanath Reddy1, G.R. Srinivas Rao2, Jagadeeswar Goud G.3, Milap Shah4

D. Viswanath Reddy, Consultant Gastroenterologist, Department of Gastroenterology, Yashoda Hospital, Secunderabad, Telangana 500003, India. , Viswanath Reddy1 , G.R. Srinivas Rao2 , Jagadeeswar Goud G.3 , Milap Shah4

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RFP Gastroenterology International 2(1-2):p 11-16, January - December 2017. | DOI:

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Abstract

Background: Mesenteric vein thrombosis due to Mesenteric fibromatosis presenting with ectopic variceal bleed is less common. Case Description: 38 year old male presented with history of large volume melena. He was resuscitated and Endoscopy was done, showed multiple ectopic varices-bleeder in Duodenal third portion, hemostasis achieved by injecting Cyanocrylate glue. On reviewing, he had evaluation for pain abdomen, a year back which suggested inoperable retroperitoneal neoplasm. He had taken alternative medicine, being given a poor prognosis. Endosonography guided aspiration from lesion was suggestive of atypical cells. After 1 year, he had re-bleeding. Glue injection was done to another bleeding varix in D3. Repeat CT scan showed similar sized retroperitoneal mass. Diagnostic laparoscopy showed Omental cake like mass, histologically - mesenteric fibromatosis. Clinical Relevance: GI Bleed is a rare manifestation of Mesenteric fibromatosis and here it was variceal bleed secondary to thrombosis of the mesenteric vein, managed endoscopically. Patient had spontaneous Mesenteric fibromatosis and is stable for few years now. Hence, all retroperitoneal lesions need complete evaluation before giving a poor prognosis. 

Keywords: Mesenteric Fibromatosis; Retroperitoneal Mass; Ectopic Variceal GI Bleeding; Glue Injection; CT abdomen; Endosonography; Diagnostic Laparoscopy; Histopathology.

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