A Case of Bleeding from a Periampullary Duodenal Varix that Developed after Biliary Metal Stent Placement in a Patient with Pancreatic Cancer / 대한소화기내시경학회지

ABSTRACT

Duodenal varices bleed less commonly than gastro-esophageal varices in patients with portal hypertension. However, if there is no stigmata of recent esophageal or gastric variceal bleeding, clinicians should suspect the presence of an extra gastro-esophageal site of variceal bleeding. Duodenal variceal bleeding can be difficult to diagnose and treat. Therefore, the bleeding may be life threatening in most cases and has a poor prognosis. We experienced a case of variceal bleeding that developed in a patient with far advanced pancreatic cancer after placement of a self- expanding metal stent into a strictured bile duct via the peroral and transpapillary route. The patient had a duodenal varix near the major papilla and the bleeding was treated with an injection of Histoacryl(R). We thought the bleeding of the periampullary varix resulted from injury due to exposure to the free end of the alloy wires in the distal portion of the inserted biliary metal stent.