Upper gastrointestinal bleeding with duodenal varix: A case report
Hannah Lee1, Yeong Heon Han1, Jun-Won Chung2
1Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, South Korea.
Background:
Ectopic varices present diagnostic and management challenges when encountered unexpectedly in clinical practice. Given their potential for fatal outcomes, with mortality rates reaching 40%, it is essential to discuss their clinical manifestations as well as current management guidelines.
Case Summary:
We report the case of a 56-year-old male patient with a history of liver transplantation and segmentectomy for hepatocellular carcinoma with underlying liver cirrhosis and chronic hepatitis B virus infection. He had previously undergone gastrojejunostomy for a perforated duodenal ulcer. The patient presented to the emergency department with hematochezia that began two days prior to his visit, shortly after discharge following recovery from upper gastrointestinal bleeding caused by an anastomotic ulcer at the gastrojejunostomy site. Initial esophagogastroduodenoscopy showed a healing anastomotic ulcer without active bleeding but revealed several hyperemic spots suggesting angiodysplastic changes near the anastomosis. Argon plasma coagulation was performed for cauterization of these microvascular changes. During admission, recurrent bleeding occurred, and abdominal computed tomography revealed portal vein (PV) and superior mesenteric vein (SMV) thrombosis, as well as a varix in the third portion of the duodenum. The patient successfully achieved hemostasis through a combination of embolization and surgical PV-SMV bypass.
Conclusion:
A systematic approach is essential for diagnosing and managing ectopic varices. Further, evidence-based studies are needed to improve outcomes.
Related Concept Videos
01:24Esophageal Varices-I: Introduction
01:28Esophageal Varices-II: Clinical Features and Management
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:26Varicose Veins II: Diagnostic Studies and Interprofessional Care
01:25Peptic Ulcer Disease III: Clinical Manifestations and Complications