title: Upper gastrointestinal bleeding in cirrhosis: varix or no varix?
abstract: Upper gastrointestinal bleeding from variceal origin is a frequent complication in the cirrhotic population. Duodenal variceal haemorrhage, however, is infrequent and the endoscopic management of such lesions is not straightforward. Non-endoscopic options include vasoactive drugs, transjugular intrahepatic portosystemic shunt (TIPS), transvenous obliteration and surgery as rescue therapy. We present a patient with Child-Pugh A hepatitis C virus-cirrhosis with acute bleeding from a duodenal varix. It was managed with elastic band ligation but late rebleeding occurred after 6 weeks. Gastroduodenoscopy revealed active bleeding from the ligation eschar. Band ligation and sclerosis were attempted but unsuccessful. Terlipressin was started and the patient referred for TIPS. Surprisingly, angiography showed a normal hepatic vein pressure gradient; therefore, TIPS was not performed. Haemorrhage ceased with medical treatment alone. The patient remained stable and was discharged after 10 days, being currently under evaluation for hepatitis C therapy.
authors.affiliation: Department of Gastroenterology and Hepatology, Centro Hospitalar Barlavento Algarvio, Portimão, Portugal. alex.fsof@gmail.com
authors.forename: Alexandre Oliveira
authors.initials: AO
authors.lastname: Ferreira
authors.forename: Helena Tavares
authors.initials: HT
authors.lastname: Sousa
authors.forename: Jorge
authors.initials: J
authors.lastname: Brito
authors.forename: Luis
authors.initials: L
authors.lastname: Rosa
mesh_terms: D004386:Duodenum / Q000098:blood supply*; D006471:Gastrointestinal Hemorrhage / Q000188:drug therapy / Q000209:etiology*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008026:Ligation; D008103:Liver Cirrhosis / Q000150:complications*; D008236:Lypressin / Q000031:analogs & derivatives / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000077585:Terlipressin; D014057:Tomography, X-Ray Computed; D014648:Varicose Veins / Q000150:complications* / Q000188:drug therapy; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D008236:Lypressin; D000077585:Terlipressin
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