{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:50:53Z","timestamp":1791287453620,"version":"4.1.0"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin J Gastroenterol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Duodenal varices are a rare form of ectopic varices that develop as a consequence of portal hypertension and may cause life-threatening gastrointestinal bleeding. Due to complex portosystemic collateral pathways, optimal treatment strategies have yet to be established. We herein report a fatal case of ruptured duodenal varices in a man in his 50s with decompensated liver cirrhosis. The patient presented with hematochezia and hemorrhagic shock. Endoscopic hemostasis was unsuccessful, and emergency transileocolic venous obliteration (TIO) was performed. Contrast-enhanced computed tomography revealed three duodenal varices located in the horizontal portion of the duodenum, supplied by the superior mesenteric vein and draining into the right testicular vein, forming a high-flow portosystemic shunt. Selective embolization of two of the bleeding varices using coils and N-butyl-2-cyanoacrylate was successfully achieved, while the third varix was intentionally preserved to avoid an excessive elevation in portal pressure. Portal vein thrombosis (PVT) subsequently developed, which may have contributed to the redistribution of portal venous flow toward the remaining untreated varix. Coil exposure and bacteremia due to Streptococcus anginosus were also observed during the clinical course. The residual varix ultimately ruptured and caused massive rebleeding. Despite additional treatment, the patient developed hepatic failure followed by multiple organ failure and died on day 47. Selective embolization of ectopic varices may change portal hemodynamics and increase pressure in residual varices, potentially leading to fatal rebleeding. This case highlights the importance of anticipating hemodynamic redistribution and considering early portal decompression strategies in the management of duodenal varices.<\/jats:p>","DOI":"10.1007\/s12328-026-02453-7","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T10:53:54Z","timestamp":1791284034000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fatal rebleeding of a residual duodenal varix caused by portal hemodynamic redistribution after selective embolization"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-9148-9594","authenticated-orcid":false,"given":"Mayumi","family":"Ehara","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takanori","family":"Matsuura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoki","family":"Shinmaru","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Sakane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuta","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Kitadai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshifumi","family":"Tada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoharu","family":"Yamanaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akihiro","family":"Umeno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuzo","family":"Kodama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"2453_CR1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/cld.95","volume":"1","author":"SK Sarin","year":"2012","unstructured":"Sarin SK, Kumar A, Angus PW, et al. Diagnosis and management of acute variceal bleeding: Asian Pacific association for study of the liver recommendations. Clin Liver Dis. 2012;1:167\u201372.","journal-title":"Clin Liver Dis"},{"key":"2453_CR2","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1053\/j.tvir.2013.02.004","volume":"16","author":"WEA Saad","year":"2013","unstructured":"Saad WEA, Lippert A, Saad NEA, Caldwell S. Ectopic varices: anatomical classification, hemodynamic classification, and hemodynamic-based management. Tech Vasc Interv Radiol. 2013;16:108\u201325.","journal-title":"Tech Vasc Interv Radiol"},{"key":"2453_CR3","doi-asserted-by":"publisher","first-page":"763","DOI":"10.1111\/j.1872-034X.2010.00690.x","volume":"40","author":"N Watanabe","year":"2010","unstructured":"Watanabe N, Toyonaga A, Kojima S, et al. Current status of ectopic varices in Japan: results of a survey by the Japan society for portal hypertension. Hepatol Res. 2010;40:763\u201376.","journal-title":"Hepatol Res"},{"key":"2453_CR4","doi-asserted-by":"publisher","first-page":"1601","DOI":"10.4254\/wjh.v7.i12.1601","volume":"7","author":"T Sato","year":"2015","unstructured":"Sato T, Yamazaki K, Toyota J, et al. Duodenal varices: a review of the literature. World J Hepatol. 2015;7:1601\u20135.","journal-title":"World J Hepatol"},{"key":"2453_CR5","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1002\/hep.28906","volume":"65","author":"G Garcia-Tsao","year":"2017","unstructured":"Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American association for the study of liver diseases. Hepatology. 2017;65:310\u201335.","journal-title":"Hepatology"},{"key":"2453_CR6","first-page":"26","volume":"47","author":"ID Norton","year":"1998","unstructured":"Norton ID, Andrews JC, Kamath PS. 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AGA clinical practice update on management of portal vein thrombosis in patients with cirrhosis. Expert Rev Gastroenterol. 2025;168:396\u2013e4041.","journal-title":"Expert Rev Gastroenterol"},{"key":"2453_CR10","doi-asserted-by":"publisher","first-page":"e00239","DOI":"10.14309\/crj.0000000000000195","volume":"6","author":"AV Palagiri","year":"2019","unstructured":"Palagiri AV, et al. Coil erosion into the duodenum following arterial embolization. ACG Case Rep J. 2019;6:e00239.","journal-title":"ACG Case Rep J"},{"key":"2453_CR11","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1002\/hep.20632","volume":"41","author":"R Wiest","year":"2005","unstructured":"Wiest R, Garcia-Tsao G. Bacterial translocation (BT) in cirrhosis. Hepatology. 2005;41:422\u201333.","journal-title":"Hepatology"},{"key":"2453_CR12","first-page":"716","volume":"48","author":"G Garcia-Tsao","year":"2008","unstructured":"Garcia-Tsao G, Lim JK, Kamath PS. 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Ethical approval was waived due to the retrospective nature of this case report.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent was obtained from the patient (or the patient\u2019s family) for the publication of this case report and accompanying images.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}]}}