Ectopic Varices Rupture in the Gastroduodenal Anastomosis Successfully Treated with N‑butyl‑2‑cyanoacrylate Injection

The termectopic varicesis used to describe dilated portosystemic collateral veins in unusual loca‑ tions other than the gastroesophageal region. We recently experienced a rare case of ectopic varices that developed in the gastroduodenal anastomosis after subtotal gastrectomy. A 70‑year‑old male with liver cirrhosis due to hepatitis C virus infection was admitted for hematemesis and tarry stool. He had received a subtotal gastrectomy with the Billroth‑I method for gastric ulcer at 46 years of age. Although emergency endoscopy revealed esophageal and gastric fundal varices there were no obvious bleeding points. After removal of the coagula ectopic varices and a fi brin plug were observed on the gastroduodenal anastomosis. During the observation blood began to spurt from the fi brin plug. N‑butyl‑2‑cyanoacrylate with lipiodol injection succeeded in hemostasis. Splenic angiography showed gastric varices feeding from a short gastric vein and the posterior gastric vein. The blood fl ow around the bleeding point as indicated by lipiodol deposition had decreased and no feeding vein was observed. Endoscopic and angiographic fi ndings are shown and the treatment for such lesions is dis‑ cussed.