![]() ![]() No active bleeding was observed, but a nipple sign was noted, indicating recent bleeding. ![]() On the other hand, a large varix was present in the second portion of the duodenum. ![]() No focus of bleeding was identified, nor was there evidence of bleeding in the esophagus or stomach. The serum AFP level was 4.07 ng/mL.Įmergency esophagogastroduodenoscopy (EGD) was performed on the day of admission ( Fig. The serology tests were negative for HBsAg, anti-HBs, and anti-HCV. His serum bilirubin level was 1.1 mg/dL, with an albumin level of 2.5 g/dL, PT-international normalized ratio of 1.15, ALP level of 363 U/L, AST level of 71 U/L, and ALT level of 18 U/L. The initial laboratory evaluation revealed a leukocyte count of 5,120/mm 3, a hemoglobin level of 7.9 g/dL, and a platelet count of 141,000/mm 3. The physical examination revealed pale conjunctiva, and the digital rectal examination was positive for dark blood. At the time of presentation, his blood pressure was 140/90 mmHg, and his pulse was 97 beats/min. He had been diagnosed with alcoholic cirrhosis seven years ago but did not undergo a regular follow-up. He disclosed a significant amount of alcohol intake (150 g daily) for more than 30 years. This case report introduces a patient with duodenal variceal bleeding who was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO).Ī 56-year-old man visited the emergency department reporting a 6-day history of melena. On the other hand, the optimal treatment modality has not been established. 4 Several therapeutic modalities are used for duodenal variceal bleeding, including endoscopic sclerotherapy, endoscopic variceal ligation, transjugular intrahepatic portosystemic shunt (TIPS), and balloon-assisted retrograde transvenous obliteration (BRTO). 3 Bleeding from the duodenal varices is rare, but bleeding can be massive and sometimes fatal. Ectopic varices account for up to 5% of all variceal bleeding, 2 and 17% of them are located in the duodenum. 1 Varices are typically located in the gastroesophageal region but can occur in the ectopic regions. Increased portal pressure may lead to the development of varices and even variceal hemorrhage. Portal hypertension, which is defined as an increase in the pressure within the portal vein, often develops in the setting of liver cirrhosis. Keywords: Duodenum Varicose veins Gastrointestinal hemorrhage Embolization, therapeutic ![]() The use of PTVO might be a viable option for the treatment of duodenal variceal bleeding. The duodenal varix was no longer visible at the follow-up esophagogastroduodenoscopy performed three months after PTVO. The patient no longer complained of melena after treatment. Coil embolization of the duodenal varix was performed via a trans-splenic approach (i.e., PTVO). Emergency esophagogastroduodenoscopy revealed a large, bluish mass with a nipple sign in the second portion of the duodenum. A 56-year-old man with a history of alcoholic cirrhosis presented with a 6-day history of melena. This paper presents a patient with duodenal variceal bleeding that was managed successfully using percutaneous trans-splenic variceal obliteration (PTVO). Unfortunately, the optimal therapeutic modality for duodenal variceal bleeding is unclear. Bleeding from duodenal varices is rare, but when bleeding does occur, it is massive and can be fatal. Abstract Duodenal varices are a serious complication of portal hypertension. ![]()
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