Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make

Abstract

We present a case of recurrent upper gastrointestinal (GI) bleeding in a man aged 57 years with primary biliary cholangitis who was ultimately diagnosed with an isolated duodenal variceal bleed, which was successfully treated with histoacryl glue injection. Duodenal varices are an uncommon presentation of portal hypertension and can result in significant GI bleeding with a high mortality. Diagnosis can be difficult and therapeutic options limited. Endoscopic variceal sclerotherapy with histoacryl glue provides an effective treatment, though endoscopists need to remain aware of and vigilant for the serious complications of this treatment option.

A case report of bleeding from a duodenal varix: Rare cause of upper gastrointestinal bleeding

“…Endoscopic ligation or injection sclerotherapy with cyanoacrylate is a useful first-line therapy [ [16] , [17] , [18] ]. However, caution must be exercised when using the cyanoacrylate injection as it can lead to complication such as migration to lungs (causing pulmonary embolism) [ 19 ], abdomen and pelvis [ 20 ]. Endoscopic haemostasis using mini loop ligation with detachable nylon loop [ 21 ], and endoscopic ultrasonography (EUS)-guided clipping [ 22 ], embolization coiling [ 23 , 24 ] were attempted, with good outcomes even in acute emergency setting.…”

Periampullary Variceal Bleeding: An Atypical Complication of Portal Hypertension

“…They are especially clinically relevant in patients known to have elevated portal pressures who are undergoing endoscopic intervention such as an ERCP. Appropriate preprocedure planning, using a multidisciplinary team approach, is important as mortality rates from bleeding duodenal varices are reportedly as high as 40% [5, 6]. …”

Periampullary Variceal Bleeding: An Atypical Complication of Portal Hypertension

“…They are especially clinically relevant in patients known to have elevated portal pressures who are undergoing endoscopic intervention such as an ERCP. Appropriate preprocedure planning, using a multidisciplinary team approach, is important as mortality rates from bleeding duodenal varices are reportedly as high as 40% [5,6]. Endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS) are the mainstay of treatment for bleeding esophageal varices; however, there are no widely accepted guidelines for treatment of a duodenal varix [6].…”