Endoscopic Band Ligation of Bleeding Duodenal Varices

Abstract

Ectopic variceal bleeding is an uncommoncause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and resource availability astreatment guidelines are lackingdue to the infrequent occurrence of bleeding ectopic varices. We present a case of a middleaged woman who presented with melena and anemia requiring transfusion. She was diagnosed with cirrhosis, and computed tomography of the abdomen revealed active bleeding at the proximal duodenum. She underwent emergent esophagogastroduodenoscopy, which showed actively bleeding duodenal varices secondary to portosystemic shunt from portal hypertension. Endoscopic hemostasis was achieved with variceal band ligation, a useful modality when alternative methods of emergent variceal management are unavailable. Given the risk of recurrent bleeding, the patient underwent embolization of varices by interventional radiology.