Bleeding from duodenal varices as an unusual complication of portal hypertension

Summary: Variceal bleeding is the most serious and often fatal complication of portal hypertension. In case of bleeding from duodenal varices, the primary endoscopic treatment is endoscopic occlusion with tissue glue (synthetic N-butyl-2-cyanoacrylate [Histoacryl®]) or ligation of the duodenal varix. If primary endoscopic treatment is not sufficient to stop variceal bleeding or if a high risk of recurrence of bleeding prevails and the patient is clinically fit for further therapy, we proceed to secondary interventional therapy – TIPS or surgery. In the presented patient, unusually, we used clipping instead of ligation in the first treatment period. Then, in the second period, the recommended occlusion with tissue glue. Our management was definitive given that the patient was suspected of having generalized hepatocellular carcinoma during hospitalization. Key words: duodenal varices – portal hypertension – endoscopy – varicose bleeding