Endoscopic Injection of a Ruptured Duodenal Varix with N-butyl-2-cyanoacrylate

Background

Gastrointestinal bleeding with origin in ectopic varices occurs in 1–5% of all portal hypertension-related bleeding episodes in the context of liver cirrhosis.

Patient and methods

We report the case of a 45-years-old patient with liver cirrhosis due to chronic hepatitis C who was admitted to the emergency department for melena with 1 day of evolution. Endoscopy revealed the presence of fresh blood in the stomach and duodenum. Although there were no visible esophageal or gastric varices, there was a large varix in the second portion of duodenum with a clear rupture point. Endoscopic injection of a total of 1 ml of N-butyl-2-cyanoacrylate mixed with 1 ml of lipiodol was performed intravariceally, which resulted in the collapse of the varix indicating a complete interruption of its blood supply. Follow-up CT scan showed the injected N-butyl-2-cyanoacrylate eradicating the duodenal varix at the second portion of the duodenum.

Result

The patient was discharged one week after the endoscopic therapy and, 7 months after this episode, remains without hemorrhagic recurrence.

Conclusions

The presented case supports endoscopic injection sclerotherapy with N-butyl-2-cyanoacrylate as a treatment option for ruptured duodenal varices that, despite being a rare event, when it occurs, is often fatal.