The Nightmare of the Gastroenterologist: Bleeding Duodenal Varices

The management of hemorrhage from duodenal varices remains controversial. Available treatment methods include endoscopic, radiological, and surgical techniques, with endoscopic therapy being the most commonly used modality.

We describe a case of a patient who underwent band ligation for large duodenal varices. Hemostasis was achieved for forty-eight hours, but the patient later suffered from severe rebleeding. Tragically, the patient passed away after surgical salvage treatment due to decompensation and infection.

In light of a review of pertinent literature, we advise against the sole use of endoscopic band ligation for large varices. It should be complemented with other treatment modalities, ideally radiological interventions such as transjugular intrahepatic portosystemic shunt or transvenous obliteration.