Therapeutic approach to "downhill" esophageal varices bleeding due to superior vena cava syndrome in Behcet's disease: a case report.
BACKGROUND
One of the rare presentations of superior vena cava syndrome is bleeding of "downhill" esophageal varices (DEV) and different approaches have been used to control it. This is a case report whose DEV was eradicated by band ligation for the first time.


METHODS
We report a 42-year-old man who is a known case of Behcet's disease. The patient's first presentation was superior vena cava syndrome due to thrombosis followed by bipolar ulcers and arthralgia. He received warfarin, prednisolone and azathioprine. The clinical course of the patient was complicated by one episode of hematemesis without abdominal pain when the patient's PT was in therapeutic range. After resuscitation and correction of PT with fresh frozen plasma transfusion, upper gastrointestinal endoscopy was done. Prominent varices were seen in the upper third of the esophagus, tapering to the middle part without acute bleeding. Stomach and duodenum were normal. Color ultrasonography evaluation of the portal, hepatic and splenic veins was negative for thrombosis. Band ligation was done and the patient's bleeding did not recur.


CONCLUSIONS
Band ligation is a safe and effective method for controlling DEV bleeding in patients with uncorrectable underlying disorders.
Tavakkoli
Hamid
H
Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran. h_tavakoli@med.mui.ac.ir
Asadi
Mehrnaz
M
Haghighi
Mahshid
M
Esmaeili
Abbas
A
D000328:Adult; D001528:Behcet Syndrome / Q000150:complications*; D015897:Comorbidity; D016099:Endoscopy, Gastrointestinal; D004932:Esophageal and Gastric Varices / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D013479:Superior Vena Cava Syndrome / Q000209:etiology*