Successful Endoscopic Treatment of Bleeding Anorectal Varices in a patient with Advanced Pancreatic Cancer

A 78-year-old female with massive hematochezia showed an extra-hepatic portal vein obstruction (EHO) and rectal varices due to advanced pancreatic cancer with computed tomography (CT).  Endoscopy revealed enlarged rectal varices and external anal varices with a reddish fibrin plug, and we diagnosed the rupture of anorectal varices near the anal verge.  We first performed endoscopic injection sclerotherapy (EIS) for rectal varices under fluoroscopy.  After EIS, endoscopic variceal ligation (EVL) was performed for the fibrin plug.  Following treatment, the patient experienced no further episodes of bleeding during the three months up to her death.