Treatment and follow-up of a case of bleeding duodenal varix

Abstract

Duodenal varices (DV) are rare in patients with portal hypertension secondary to liver disease. Their tendency to bleed is less common than in gastroesophageal varices, but can sometimes produce a life-threatening bleed. They are often difficult to diagnose and treat. We present a case of a 35-year-old man with parenchymal liver disease admitted with complaints of hematemesis and melena. Upper gastrointestinal endoscopy was performed and a duodenal varix, with stigmata of a recent bleed, was noted in the second part of the duodenum. Five milliliters of N-butyl-2-cyanoacrylate glue was injected into the varix leading to obliteration. A follow-up study with an endoscopic ultrasound and repeat endoscopy showed near total obturation of the varix and success of the therapy. This report concludes that glue injection can effectively be used as a first-line treatment for bleeding duodenal varices.

Effectiveness and safety of endoscopic treatment for duodenal variceal bleeding: a systematic review

“…First, because duodenal varices may cause massive bleeding, a safer, easier, and faster therapy was considered to be preferable. Endoscopic intervention is effective, less invasive, and easier and faster to perform compared with interventional radiology and surgical procedures [ 43 , 53 , 55 ]. Second, given the anatomical characteristics of duodenal varix that are often located deep in the serosal layer of the duodenum, it is difficult to achieve long-term eradication of varices with EBL alone given the insufficient effect of EBL on the feeding collateral vessels [ 40 , 51 , 53 , 56 ].…”

“…Cyanoacrylate rapidly polymerizes upon contact with blood and embolizes varix [ 48 , 51 ]. Therefore, many investigators prefer cyanoacrylate rather than ethanolamine oleate in the treatment of variceal bleeding because N -butyl-2-cyanoacrylate causes less tissue damage than other agents [ 43 , 55 , 60 ].…”