An 80-year-old Japanese male with alcoholic cirrhosis and esophageal varices was scheduled for the endoscopic treatment of incidentally discovered rectal varices. Prior to his admission, bleeding in the lower gastrointestinal tract due to ruptured rectal varices was observed, and endoscopic variceal ligation (EVL) was performed to stop the bleeding. Intraluminal ultrasonography (IDUS) was performed to identify the puncture site of the rectal varix in the F2 morphology, and a submucosal rectal varix was incidentally detected which was indistinguishable from the endoscopic findings. We decided to perform endoscopic injection sclerotherapy with simultaneous ligation (EISL) at the same site. Seven days later, contrast-enhanced CT showed thrombosis of the varicocele, and the patient was discharged from the hospital. The submucosal varicocele, which could not be identified by gross findings, was successfully intra-injected by using IDUS to determine the puncture site. EISL to minimize post-puncture hemorrhaging and to save the patient's life was successful.
