Hemorrhagic shock due to ileal varices, a diagnostic challenge

Gastrointestinal bleeding due to portal hypertension is a major complication in patients with cirrhosis, commonly attributed to esophagogastric varices. However, bleeding from ectopic varices accounts for 5% of variceal bleeding cases and it may occur at lower pressures than esophageal varices. Thus, ectopic varices should be considered in patients with portal hypertension that present with gastrointestinal bleeding lacking evidence of esophagogastric variceal bleeding on upper gastrointestinal endoscopy. We present the case of a patient with cirrhosis that had recurrent hemorrhagic shock due to small intestinal varices that were diagnosed via capsule endoscopy.