Ectopic varices and collaterals development after band ligation treatment in a patient with portal hypertension

Abstract

Esophageal and gastric varices may complicate the course of cirrhosis as a direct consequence of portal hypertension. Variceal hemorrhage has been reported to occur in 25-40% of patients with cirrhosis [Gastroenterol Clin North Am 1992;21:149-161]. Occasionally, varices develop at sites other than the esophagus and are detected either when they bleed or incidentally during upper or lower endoscopy [Eur J Gastroenterol Hepatol 2006;18:1155-1160; Digestion 2000;61:149-150]. Endoscopic treatment is often unsuccessful in these cases, and traditional treatment is usually surgical, while it has been suggested that bleeding can also be controlled by a transjugular intrahepatic portosystemic shunt (TIPS) [Endoscopy 1995;27:626-627]. Moreover, esophageal band ligation may interfere with the collateral web. We here report a case of an ectopic duodenal varix and the development of a large collaterals web that appeared after band ligation.

Keywords: Duodenal varice; Ectopic varice; Portal hypertension.

Fig. 1

a Serpiginous blue mass in the duodenum at endoscopy. b Duodenal vessel that perforates the duodenal wall with protrusion into the digestive lumen as seen at EUS.

Fig. 2

a Moderate web of periesophageal collaterals (arrows). b Massive web of portosystemic collaterals developed around the esogastric junction as seen at EUS.