{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,27]],"date-time":"2025-11-27T16:10:34Z","timestamp":1764259834179,"version":"3.44.0"},"reference-count":17,"publisher":"BMJ","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ Case Reports"],"abstract":"<jats:p>Upper gastrointestinal bleeding from variceal origin is a frequent complication in the cirrhotic population. Duodenal variceal haemorrhage, however, is infrequent and the endoscopic management of such lesions is not straightforward. Non-endoscopic options include vasoactive drugs, transjugular intrahepatic portosystemic shunt (TIPS), transvenous obliteration and surgery as rescue therapy. We present a patient with Child-Pugh A hepatitis C virus-cirrhosis with acute bleeding from a duodenal varix. It was managed with elastic band ligation but late rebleeding occurred after 6\u2005weeks. Gastroduodenoscopy revealed active bleeding from the ligation eschar. Band ligation and sclerosis were attempted but unsuccessful. Terlipressin was started and the patient referred for TIPS. Surprisingly, angiography showed a normal hepatic vein pressure gradient; therefore, TIPS was not performed. Haemorrhage ceased with medical treatment alone. The patient remained stable and was discharged after 10\u2005days, being currently under evaluation for hepatitis C therapy.<\/jats:p>","DOI":"10.1136\/bcr-2013-008815","type":"journal-article","created":{"date-parts":[[2013,7,29]],"date-time":"2013-07-29T08:01:03Z","timestamp":1375084863000},"page":"bcr2013008815","source":"Crossref","is-referenced-by-count":2,"title":["Upper gastrointestinal bleeding in cirrhosis: varix or no varix?"],"prefix":"10.1136","volume":"2013","author":[{"given":"Alexandre Oliveira","family":"Ferreira","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centro Hospitalar Barlavento Algarvio, Portim\u00e3o, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena Tavares","family":"Sousa","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Centro Hospitalar Barlavento Algarvio, Portim\u00e3o, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Brito","sequence":"additional","affiliation":[{"name":"Department of Radiology, Centro Hospitalar Barlavento Algarvio, Portim\u00e3o, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Rosa","sequence":"additional","affiliation":[{"name":"Department of Radiology, Funda\u00e7\u00e3o Champalimaud, Lisbon, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2013,7,29]]},"reference":[{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.1","doi-asserted-by":"crossref","first-page":"514","DOI":"10.2214\/ajr.129.3.514","article-title":"Bleeding ileal varicosity demonstrated by transhepatic portography","volume":"2013","author":"Kinkhabwala","year":"1977","journal-title":"AJR Am J Roentgenol"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.2","first-page":"548","article-title":"Duodenal varices as a cause of massive upper gastrointestinal bleeding","volume":"2013","author":"Khouqeer","year":"1987","journal-title":"Surgery"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.3","doi-asserted-by":"crossref","first-page":"322","DOI":"10.1007\/s12072-008-9074-1","article-title":"Updates in the pathogenesis, diagnosis and management of ectopic varices","volume":"2013 2013","author":"Helmy","year":"2008","journal-title":"Hepatol Int"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.4","doi-asserted-by":"crossref","unstructured":"Malik A Junglee N Khan A . Duodenal varices successfully treated with cyanoacrylate injection therapy. BMJ Case Rep. 2013 Published Online: 25 May 2011. doi:10.1136\/bcr.02.2011.3913.","DOI":"10.1136\/bcr.02.2011.3913"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.5","doi-asserted-by":"crossref","first-page":"5912","DOI":"10.3748\/wjg.v18.i41.5912","article-title":"Human thrombin for the treatment of gastric and ectopic varices","volume":"2013","author":"McAvoy","year":"2012","journal-title":"World J Gastroenterol"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.6","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1093\/qjmed\/hcr030","article-title":"EUS-assisted thrombin injection for ectopic bleeding varices\u2014a case report and review of the literature","volume":"2013","author":"Krystallis","year":"2012","journal-title":"QJM"},{"key":"2025082801212656000_2013.jul29_1.bcr2013008815.7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1046\/j.1365-2036.2003.01356.x","article-title":"Systematic review: terlipressin in acute esophageal variceal 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