Hemorrhagic shock due to rupture of duodenal varices

A 61-year-old woman was admitted to our hospital for melena and convulsion in shock state. Laboratory data on admission indicated severe anemia and marked liver dysfunction. She improved clinically, after received a large blood transfusion. Angiographic study was performed, and portography revealed duodenal varices supplied via superior mesenteric artery and drained to the left ovarian vein. An endoscopic examination was performed, and large nodular varices were observed in the third portion of the duodenum. The varices were treated by percutaneous transhepatic obliteration of portal systemic collaterals (PTO), and endoscopic injection sclerotherapy (EIS) with n-butyl-2-cyanoacrylate (Histoacryl). After complection of EIS, no further bleeding occurred, and the patient's hemoglobin level was stabilized. No recurrence of the duodenal varices has been detected during the follow-up period of five months after EIS with N-butyl-2-cyanoacrylate.