Abstract
A 55-year-old woman with alcoholic liver cirrhosis was admitted to our hospital because of hemorrhagic shock after repeated episode of tarry stool. Endoscopic examination disclosed a solitary duodenal varix at the third portion of the duodenum with white plug on the surface. EVL was performed for the varix, and she recovered from hemorrhagic shock. Additional therapy was not done, because both trans-superior mesenteric arterial portography and magnetic resonance angiography revealed no collateral vessels toward the esophagus, stomach and duodenum. At 4 months later, tarry stool recurred. On endoscopic examination, there was a newly developing duodenal varix at anal side of the third portion of the duodenum, which was treated with EVL. However, intestinal endoscopic examination performed 7 days later revealed another small varix at the same side, but this varix was not treated. She was followed up only by endoscopical observation thereafter, and was quite well for 8 months despite of the remaining varix. It is concluded that EVL may be useful as an emergent therapy for massive hemorrhage from ruptured duodenal varices, but from the prognostic aspect, its efficacy must be evaluated precisely in future.
