Duodenal Varices: A Rare Cause of Gastrointestinal Bleeding

Endoscopic Band Ligation of Bleeding Duodenal Varices

“…The pathophysiologyof varices is related toincreased portal venous pressure, usually secondary to liver cirrhosis, which leads to portosystemiccollateral pathways. Other causes of portal hypertension include a portal or splenic vein occlusion, tumor invasion, or thrombosis [2][3][4]. The diagnosis of duodenal varices is bestaccomplishedviadirect visualization byendoscopy, though a small or distal varix can be misdiagnosed even by an experienced operator.…”

“…The diagnosis of duodenal varices is bestaccomplishedviadirect visualization byendoscopy, though a small or distal varix can be misdiagnosed even by an experienced operator. Clinicians should maintain a high index of suspicion for ectopic varices in a patient who continues to show signs of bleeding despite adequate treatment of esophageal varices since bleeding duodenal varices can be devastating [2,3,5]. Additional diagnostic tests can be performed for the diagnosis of ectopic varices, including computed tomography with intravenous contrast, tagged red blood cell scans, mesenteric angiography, and rarely, surgical exploration [4,6].…”

“…Although the stomach and esophagus are the most common sites of varices, they can infrequently be found in ectopic locations such asthe rectum, appendix, small intestine, colon, and biliary tract [1]. Ectopic variceal bleeding is an uncommon phenomenon, occurring in approximately 2%-5% of variceal bleeding [1].Duodenal varices account foronly17% of total ectopic variceal bleeding and havean estimated mortality rate of 40%, attributed to increased vascularity of the duodenum and the deep serosal location of duodenal varices [1][2][3]. Management of bleeding ectopic varices usually requires an endoscopic treatment or radiologic intervention and rarely surgical intervention.…”