S2671 Upper Gastrointestinal Bleeding Due to Duodenal Ischemia: A Case Series

Abstract

Discussion: Ectopic varices account for up to 5% of variceal bleeds with a bleeding rate thought to be 4 times higher than esophageal varices and a reported mortality up to 40%. About 17% are jejunal/ileal varices. Rapid detection and treatment by embolization and reduction in portal pressures via TIPS, BRTO or portal vein stenting are key. In our patient, despite delay in diagnosis due to intermittent bleeding, hemostasis was finally achieved with direct embolization and reduction in portal pressure. It is imperative that a high suspicion be maintained for ectopic varices in any patient with portal hypertension and intra/extraluminal signs of bleeding, and other modalities such as MRA or CT enterography be utilized if endoscopy/CTA are non-revealing.[2668] Figure 1. Figure: (a) Sagittal view of computed tomography angiography (CTA) and (b) angiogram evidence of jejunal blush and ectopic jejunal varix with aberrant connection to the left ovarian vein, respectively.