Ruptured duodenal varices successfully treated by mini-loop ligation: report of a case

Bleeding from duodenal varices is a rare, but often fatal manifestation of portal hypertension and these ectopic varices are more common in extrahepatic portal venous obstruction. There are over 160 cases of duodenal varices reported in the English literature. A 47-year-old female presented with massive hematemesis and prolonged shock. Initial endoscopy revealed non-bleeding small esophageal varices and large varices in the first portion of the duodenum with spurting bleeding. Endoscopic hemostasis was obtained with 5 detachable nylon loops. Portal hypertension was caused by liver cirrhosis and postthrombotic portal cavernoma. To the best of our knowledge this is the first case of successful mini-loop ligation of bleeding duodenal varices reported in the literature.