Abstract
A45-year-old male with alcoholic liver cirrhosis presented duodenal varices 2 years after repeated endoscopic treatments for esophageal varices. Upper GI endoscopy syowed risky varices with erosions in the therd portion of the duodenum. By MR angiography, portal thrombi were recognized in the main trunk of the portal vein and the intrahepatic portal veins. Abdominal angiography revealed the inferior pancreaticoduodenal vein as an afferent vein of the varices. The efferent vein drained into the right gonadal vein, and finally into the inferior vena cave through the left renal vein. A nameless shunt vessel was found between the varices and the right gonadal vein. Dual balloon occluded embolotherapy (DBOE) was performed for the treatment, but it failed in sclerosing duodenal varices. Finally, the varices were treated with endoscopic injection sclerotherapy using n-butyl-2-cyanoacrylate (Histoacryl), and sclerosed complerely. This case was instructive for understanding of the complicated collaterals and making decision of the treatment in duodenal varices.
