Qurratulain Hyder, Asif Ayub.
Duodenal varices: A rare cause of Upper Gastrointestinal Bleeding.
J Coll Physicians Surg Pak Jan ;9(2):106-8.

An experience of sclerotherapy in duodenal varices in a 50 year old female with extrahepatic portal vein obstruction (EHPVO) is presented here. Single injection of 3% sodium tetradecyl (STD) proved effective in preventing recurrence of variceal haemorrhage during two year follow-up in this patient. Five cases with acute bleeding from duodenal varices, have been reported earlier. It is, therefore, concluded that sclerotherapy of duodenal varices is an effective first-line treatment. Prognosis is better with non-cirrhotic etiology of portal hypertension in such cases.

CASE REPORT: In December 1994, a fifty year old female with single episode of moderate UGI bleeding was admitted. Black tarry stools had persisted for 3 days prior to admission. There was no history of jaundice, fever, abdominal pain, surgery or blood transfusion. She used analgesics for occasional headache but had been in good health, previously. Diagnostic gastroscopy was performed 18 hours later. It showed two nonbleeding gastric varices and some prominent varices in the duodenal bulb. Cherry-red spots on one duodenal varix were suggestive of recent haemorrhage. Sclerotherapy of the latter varix was performed with 3 ml of 3% STD, to prevent rebleeding. Abdominal ultrasound demonstrated numerous vascular channels at the porta hepatis and around proximal duodenum. Portal vein could not be recognised. The pancreas was normal. However, coarse echotexture of the liver raised suspicion of a right lobe hepatic neoplasm. She was followed up on outdoor basis for approximately 2 years, until January 1997. Her laboratory workup then was normal. Partially obliterated duodenal varices persisted on gastroscopy. She was apparently well preserved and remained largely asymptomatic, despite poor compliance.

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