Cyanoacrylate Treatment of Gastric Varices Case Study 4: Bleeding Duodenal Varices

Background

A 42-year-old male with a history of necrotizing biliary pancreatitis complicated by splenic vein thrombosis presented with episodic transfusion-dependent melena. Multiple upper and lower endoscopies, RBC tagged scans, and small bowel radiographs were unrevealing of a bleeding source. Capsule endoscopy was performed, but the capsule failed to exit the stomach. A follow-up endoscopy suggested possible duodenal varices.

Treatment

Upper endoscopy showed serpiginous areas of mucosal elevation in the duodenal bulb that were “soft” on palpation. Endoscopic ultrasonography confirmed duodenal varices. Cyanoacrylate glue was injected to obliterate the varices.

Outcome

Follow-up endoscopy one month later showed glue extruding from the site of previous glue injection. The varices were “hard” to instrumental palpation. No further bleeding was observed over the next 6 months.