A 69-year-old male with a history of Child stage B alcoholic liver cirrhosis and portal hypertension.
She was admitted with a diagnosis of grade I-II hepatic encephalopathy.
Twenty-four hours after admission, she had worsening of encephalopathy III-IV and melenic stools.
Urgent gastroscopy showed no signs of active bleeding and no evidence of esophageal varices.
An abdominal-pelvic CT scan showed signs of liver cirrhosis with portal hypertension, ascites and the presence of increased caliber peripheral vessels at the cecal area.
After several episodes of gastrointestinal bleeding, the patient was diagnosed with ileum remnants.
Therefore, enteroscopy was performed without objectifying to the esophagus or stomach varices or remnants helium.
In the second portion of the duodenum, several nipples of varicose aspect were visualized with jet bleeding by one of them, after sclerosing with ethoxysclerol (cirilization with 1 %) increased bleeding.
It was explored as far as and associate, without visualizing more nipples suggestive of varices.
After enteroscopy, the patient presented a progressive decrease in the level of consciousness (Glasgow 3); as well as deterioration of renal, cardiac and neurological therapeutic function; hepatic failure due to stress limitation, and later died secondary.
