Massive gastrointestinal bleeding due to ectopic varix in distal duodenum: a case report

Area of Science:

• Gastroenterology
• Vascular Surgery
• Interventional Radiology

Background:

• Duodenal ectopic varices (DEV) are an uncommon cause of upper gastrointestinal bleeding, presenting diagnostic and management challenges.
• High mortality rates are associated with DEV, necessitating effective treatment strategies.
• Treatment options vary and depend on vascular anatomy and underlying pathology.

Observation:

• A 41-year-old male with a history of alcohol use disorder and splenic vein thrombosis presented with massive gastrointestinal bleeding.
• Diagnosis revealed a distal duodenal ectopic varix with unique inflow from the superior mesenteric vein and outflow into the left renal vein.
• The patient's complex vascular anatomy posed significant management challenges.

Findings:

• Successful treatment of the duodenal ectopic varix was achieved using a transjugular portosystemic shunt (TIPS) and coil embolization.
• This interventional radiology approach effectively managed the massive gastrointestinal bleeding.
• The case demonstrates the utility of TIPS in managing complex DEV cases with unusual vascular connections.

Implications:

• Transjugular intrahepatic portosystemic shunt (TIPS) is a viable and effective treatment for duodenal ectopic varices, particularly in complex cases.
• Understanding the specific vascular anatomy is crucial for successful management of DEV.
• This case expands the therapeutic options for managing rare and life-threatening gastrointestinal bleeding from ectopic varices.