case_images: PMC11784405_01
case_images: Small bowel endoscopy image using colonoscopy. Varices at the hepaticojejunostomy site (arrows) are large and erythematous. They were considered unamenable via endoscopic treatment because endoscopic procedures cannot provide adequate hemostasis and may likely induce major bleeding.
case_images: cureus-0017-00000076731-i01.jpg
case_images: PMC11784405_01_cureus-0017-00000076731-i01.jpg
case_images: FIG1
case_images: The varices were accompanied by nipple-like protrusions and erythema (Figure 1).
case_images: CT of the abdomen. (A) Axial CT image of the upper abdomen showing jejunal varices (arrows) at the hepaticojejunostomy site. (B) Axial CT image 8 cm lower than (A) showing a continuous jejunal vein (arrow) with the jejunal varices. (C) Anterior view of three-dimensional CT showing the portal venous system. The varices (purple) are continuous with the jejunal vein (blue). The distal part of the SMV (white arrow) is visualized, but the proximal part of the SMV is occluded. Yellow arrows show the direction of the venous flow from the small intestine to the PV via the collateral vein and the inferior mesenteric vein. The central part of the collateral vein is made transparent to simplify the vascular anatomy presentation.. SpV: splenic vein, CT: computed tomography, SMV: superior mesenteric vein, PV: portal vein, IMV: inferior mesenteric vein
case_images: cureus-0017-00000076731-i02.jpg
case_images: PMC11784405_01_cureus-0017-00000076731-i02.jpg
case_images: FIG2
case_images: Jejunal varices were observed at the hepaticojejunostomy site, and a dilated jejunal vein was the afferent vein of the varices (Figure 2).
case_images: Ultrasound images of the jejunal vein continuous with the jejunal varices at the hepaticojejunostomy site. (A) The ultrasound image in the transverse plane clearly visualizes the jejunal vein (arrow) without overlying bowels. (B) The jejunal vein (arrow) becomes flattened upon gentle compression. (C) Ultrasound image in the sagittal plane reveals that the jejunal vein (arrow) runs straight, and a puncture of the vein seems feasible.
case_images: cureus-0017-00000076731-i03.jpg
case_images: PMC11784405_01_cureus-0017-00000076731-i03.jpg
case_images: FIG3
case_images: On ultrasound, the jejunal vein was clearly observed without overlying bowels (Figure 3).
case_images: Angiography during variceal embolization via percutaneous access to the jejunal vein. (A) Angiography of the jejunal vein reveals jejunal varices (arrow). A collateral vessel (arrowhead) is also observed. (B) After embolization, jejunal varices are not opacified. Note that the collateral vein (arrowhead) is preserved.
case_images: cureus-0017-00000076731-i04.jpg
case_images: PMC11784405_01_cureus-0017-00000076731-i04.jpg
case_images: FIG4
case_images: Venography revealed jejunal varices and collateral veins (Figure 4A). Venography revealed obliteration of the varices, with preservation of the collateral veins (Figure 4B).