Upper gastrointestinal bleeding with duodenal varix: A case report.

[BACKGROUND] Ectopic varices present diagnostic and management challenges when encountered unexpectedly in clinical practice. Given their potential for fatal outcomes, with mortality rates reaching 40%, it is essential to discuss their clinical manifestations as well as current management guidelines.

[CASE SUMMARY] We report the case of a 56-year-old male patient with a history of liver transplantation and segmentectomy for hepatocellular carcinoma with underlying liver cirrhosis and chronic hepatitis B virus infection. He had previously undergone gastrojejunostomy for a perforated duodenal ulcer. The patient presented to the emergency department with hematochezia that began two days prior to his visit, shortly after discharge following recovery from upper gastrointestinal bleeding caused by an anastomotic ulcer at the gastrojejunostomy site. Initial esophagogastroduodenoscopy showed a healing anastomotic ulcer without active bleeding but revealed several hyperemic spots suggesting angiodysplastic changes near the anastomosis. Argon plasma coagulation was performed for cauterization of these microvascular changes. During admission, recurrent bleeding occurred, and abdominal computed tomography revealed portal vein (PV) and superior mesenteric vein (SMV) thrombosis, as well as a varix in the third portion of the duodenum. The patient successfully achieved hemostasis through a combination of embolization and surgical PV-SMV bypass.

[CONCLUSION] A systematic approach is essential for diagnosing and managing ectopic varices. Further, evidence-based studies are needed to improve outcomes.