A Successful Endoscopic Injection Sclerotherapy of a Bleeding Duodenal Varix

Choi, Hyun; Cheun, Kyung Il; Lee, Seung Chul; Hong, Suk Kyung; Han, Jae Ryong; Kim, Young Chul; Jo, Kyoung Geun; Na, Moon Jun; Choi, Duck Yeii; Park, Seong Kyu

Abstract

Bleeding frorn the duodenal varix is an unusual event. Upper gastrointestinal endoscopy is the diagnostic procedure of choice in diagnosing duodenal varices. If performed during active bleeding, it can differentiate between esophageal and duodenal varices as the source, which has important therapeutic implications. A thorough examination of the duodenum for varices is important in an upper gastrointestinal hemorrhage. Treatment modalites for bleeding duodenal varices are sclerotherapy, varix suture ligation, portocaval shunt, and duodenal resection. Although endoscopic sclerotherapy has lirnited success in controlling active duodenal varix as initial treatment, endoscopic injection sclerotherapy is a useful first-line therapeutic measure in the treatment of bleeding duodenal varices. In this study we present a case of a ruptured duodenal varix, which was defected by an endoscopy, in a 61-year-old male. An endoscopic examination showed small and nonbleeding esophageal varices and a prominant ulcerated varix was identified in the 2nd portion of the duodenum. Endoscopic sclerotherapy was performed by injecting ethanolamine oleate into the varix. Our report demonstrate that endoscopic sclerotherapy can be efficient even in the presence of acute bleeding and that it can provide a definitive method of curing of a bleeding duodenal varix.