2026 Volume 29 Issue 2 Pages 153-158
Ruptured varices are life-threatening, and rapid hemostatic intervention directly affects survival. Endoscopic hemostasis is generally considered the first-line treatment; however, it can be difficult when visualization is poor or when the patient presents with respiratory or circulatory failure. Here, we report a case of gastric variceal rupture in which endoscopic hemostasis was not feasible and was successfully managed with variceal embolization via a paraumbilical vein. The patient was a female aged 77 years who developed hemorrhagic shock and hypoxemia due to gastric variceal rupture associated with liver cirrhosis. Endoscopic hemostasis was attempted; however, it could not be completed because of poor visualization caused by continuous hematemesis and the patient’s worsening condition. Transhepatic variceal embolization via intrahepatic portal puncture was considered unsuitable due to massive ascites. Therefore, percutaneous puncture of a dilated paraumbilical vein was performed, and varices from the posterior gastric vein were embolized using n-butyl cyanoacrylate. The postoperative course was uneventful, without rebleeding, and the patient was discharged home. Variceal embolization via a paraumbilical vein can be an effective and safe life-saving option for patients in whom endoscopic hemostasis or a transhepatic approach is not feasible.
