Oesophageal varices: a potentially fatal complication of liver metastases

Haemorrhage from oesophageal varices is a common and potentially life-threatening complication of portal hypertension, which is usually due to cirrhosis of the liver. Although liver metastases and hepatic dysfunction frequently occur in malignant disease, reports of oesophageal varices arising as a consequence of metastatic liver disease are sporadic, suggesting that this complication is unusual. Indeed, one review of the literature identified only 23 cases, although a few others have subsequently been reported. The management of such patients bleeding from oesophageal varices is clearly very different from bleeding due to other causes such as peptic ulceration. We report three cases and review the literature. All of our cases presented to us within a period of one year, suggesting that this complication of metastatic liver disease is more common than originally considered to be the case.