Upper gastrointestinal bleeding with duodenal varix: A case report

Figure 1 Endoscopic examination. A: Anastomosis site active ulcer with Forrest IIb was controlled with argon plasma coagulation and clipping; B: Argon plasma coagulation was performed for cauterization of angiodysplastic change nearby anastomosis site; C: Vascular cauterization was performed at broad vascular change with hyperemia on afferent loop.

Figure 2 Abdominal computed tomography. A: On the coronal view, there was portal vein (orange arrow) and superior mesenteric vein thrombus as well as duodenal varix of 3^rd portion (yellow arrow); B: On the axial view, there was duodenal varix at the 3^rd portion (yellow arrow).

Figure 3 Interventional radiology. Embolization with 33% glue and 4 micro-coils at draining vein of duodenal varix for hemostasis.

Figure 4 Intra-abdominal vein bypass surgery. There was upstream thrombosis and severe stricture and portal vein side wall was exposed for side-to-side anastomosis both side with cadaveric iliac vein graft (arrow).