A 65-year-old woman with a history of alcoholic liver cirrhosis, Child stage B, with no signs of portal hypertension.
He was admitted with a diagnosis of hepatic encephalopathy III-IV.
A few hours after admission, the patient presented melena and hematochezia.
Urgent gastroscopy showed no esophageal varices or stomach changes.
In the bulb and first duodenal portion, fresh blood remains, and in the second duodenal portion there was evidence of thick duodenal varice with active bleeding in jet.
It was sclerosed with 6 cc of ethoxysclerol (1 %) and two bands in the varice, achieving the cesion of bleeding.
A new episode of bleeding occurred 24 hours after endoscopic treatment, with Hb values of 5 g/dl.
Urgent gastroscopy showed deep ulcer with adhered clot and active drooling bleeding in the second duodenal portion.
Radial endoscopy showed a clear varice adjacent to the ulcerated area.
Placement and fixation (cyanoacrylate) 1 cc were performed in the varice area.
It was explored and not visualized other lesions.
She presented new episodes of mild bleeding with progressive anaemia but without the need for further endoscopies.
The following weeks the patient had multiple complications but without new episodes of gastrointestinal bleeding: spontaneous bacterial peritonitis, ischemic stroke of the right middle cerebral artery and pneumonia.
The patient was disconnected from mechanical ventilation and died 90 days after admission.
