Lee H, Han YH, Chung JW, Kim KO, Kwon KA, Kim JH. Upper gastrointestinal bleeding with duodenal varix: A case report. World J Clin Cases 2026; 14(4): 116648 [DOI: 10.12998/wjcc.v14.i4.116648]
Corresponding Author of This Article
Jun-Won Chung, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea. junwonchung@daum.net
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Gastroenterology & Hepatology
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Feb 6, 2026 (publication date) through Feb 11, 2026
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World Journal of Clinical Cases
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2307-8960
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Lee H, Han YH, Chung JW, Kim KO, Kwon KA, Kim JH. Upper gastrointestinal bleeding with duodenal varix: A case report. World J Clin Cases 2026; 14(4): 116648 [DOI: 10.12998/wjcc.v14.i4.116648]
World J Clin Cases. Feb 6, 2026; 14(4): 116648 Published online Feb 6, 2026. doi: 10.12998/wjcc.v14.i4.116648
Upper gastrointestinal bleeding with duodenal varix: A case report
Hannah Lee, Yeong Heon Han, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Jung Ho Kim
Hannah Lee, Yeong Heon Han, Jun-Won Chung, Kyoung Oh Kim, Kwang An Kwon, Jung Ho Kim, Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, Incheon 21565, South Korea
Co-first authors: Hannah Lee and Yeong Heon Han.
Author contributions: Chung JW designed the report and determined the clinical significance of the case; Chung JW, Lee H, and Han YH collected and analyzed the clinical and imaging data; Lee H analyzed the data and wrote the manuscript; Chung JW, Lee H, and Han YH treated the patient in this case; Chung JW, Kim KO, Kwon KA, and Kim JH supervised the clinical interpretation and manuscript development; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Won Chung, MD, PhD, Professor, Division of Gastroenterology, Department of Internal Medicine, Gachon University Gil Medical Center, College of Medicine, Gachon University, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 21565, South Korea. junwonchung@daum.net
Received: November 17, 2025 Revised: January 2, 2026 Accepted: January 19, 2026 Published online: February 6, 2026 Processing time: 80 Days and 14.6 Hours
Abstract
BACKGROUND
Ectopic varices present diagnostic and management challenges when encountered unexpectedly in clinical practice. Given their potential for fatal outcomes, with mortality rates reaching 40%, it is essential to discuss their clinical manifestations as well as current management guidelines.
CASE SUMMARY
We report the case of a 56-year-old male patient with a history of liver transplantation and segmentectomy for hepatocellular carcinoma with underlying liver cirrhosis and chronic hepatitis B virus infection. He had previously undergone gastrojejunostomy for a perforated duodenal ulcer. The patient presented to the emergency department with hematochezia that began two days prior to his visit, shortly after discharge following recovery from upper gastrointestinal bleeding caused by an anastomotic ulcer at the gastrojejunostomy site. Initial esophagogastroduodenoscopy showed a healing anastomotic ulcer without active bleeding but revealed several hyperemic spots suggesting angiodysplastic changes near the anastomosis. Argon plasma coagulation was performed for cauterization of these microvascular changes. During admission, recurrent bleeding occurred, and abdominal computed tomography revealed portal vein (PV) and superior mesenteric vein (SMV) thrombosis, as well as a varix in the third portion of the duodenum. The patient successfully achieved hemostasis through a combination of embolization and surgical PV-SMV bypass.
CONCLUSION
A systematic approach is essential for diagnosing and managing ectopic varices. Further, evidence-based studies are needed to improve outcomes.
Core Tip: Ectopic varices occur at uncommon sites outside the typical locations of esophageal or gastric varices, making their assessment and management particularly challenging. We report the case of a 56-year-old male with a history of liver transplantation and segmentectomy for hepatocellular carcinoma with underlying liver cirrhosis and hepatitis B virus infection. Successful hemostasis was achieved through a combination of embolization and surgical portal vein and superior mesenteric vein bypass.
