Int J Gastrointest Interv  https://doi.org/10.18528/ijgii190002
A case report of bleeding from duodenal varices treated with percutaneous transhepatic obliteration
Ji Hyun Lee1,2, Tae Hwan Kim3, Jong Won Choi1,* , Sun Young Kim1, Jin Young Choi1, Chun Kyon Lee1, Byung Kyu Park1, and Jae Bok Chung1
1Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
3Department of Vascular and Interventional Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang 10444, Korea.
E-mail address: nicewon@hanmail.net (J.W. Choi). ORCID: https://orcid.org/0000-0001-9546-7313
Received: April 5, 2019; Revised: May 8, 2019; Accepted: May 8, 2019; Published online: June 10, 2019.
© Society of Gastrointestinal Intervention. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Duodenal varices are ectopic in nature and account for 40% of all ectopic bleeding cases. Ectopic variceal bleeding is rare (1%–5% of all variceal bleeding cases). The three principle approaches used to treat duodenal varices are endoscopic procedures, interventional radiological methods, and surgical interventions. A 59-year-old male with alcoholic liver cirrhosis and chronic hepatitis B infection visited our gastroenterology department with melena. Gastroduodenoscopy and computed tomography identified varices in the second part of the duodenum. We performed percutaneous transhepatic obliteration using glue and coil embolization, which obliterated the varices and resulted in immediate hemostasis. However, 3 months later, he re-visited presenting with newly developed duodenal varices and underwent endoscopic injection sclerotherapy.
Keywords: Duodenal varices; Ectopic varices; Endoscopic injection sclerotherapy; Percutaneous transhepatic obliteration


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