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Duodenal varices pose a significant clinical challenge due to their association with severe gastrointestinal bleeding. This condition requires attention because of its acute severity, high morbidity, and mortality rates. The presented case underscores the importance of advancing both knowledge and treatment approaches for duodenal varices. This pursuit is aimed not only at improving immediate clinical outcomes but also at deepening our understanding of complications related to portal hypertension.

Duodenal varices usually occur due to portal hypertension and are rare causes of gastrointestinal tract bleeding. We report a unique case of a previously fit patient who presented with melena and was found to have isolated duodenal varices (DV) in the third part on esophagogastroduodenoscopy. No esophageal or gastric varices were noticed. The duodenal varices were successfully managed by endoscopic banding. A computerized tomography scan of the abdomen to further investigate the cause confirmed duodenal varices and revealed superior mesenteric vein thrombosis. The liver was normal with patent hepatic and portal veins. No evidence of thrombophilia was found. Apixaban was prescribed for superior mesenteric vein thrombosis and on follow-up. no further bleeding was reported.

A 55-year-old patient was admitted for variceal treatment, a complication of chronic portal hypertension and liver cirrhosis. Imaging studies revealed prominent duodenal varices, the pancreaticoduodenal vein as its afferent pathway, a drainer vessel into the inferior vena cava, and a paraumbilical vein. We successfully performed complete obliteration of the varix, including its afferent and efferent vessels, via the paraumbilical vein approach.

Duodenal varices (DVs) are ectopic gastrointestinal varices (ECVs) associated with portal hypertension (PH). We present the case of an 82-year-old woman who presented with symptomatic anemia secondary to DV hemorrhage diagnosed on oesophagogastroduodenoscopy. This lesion was treated with endoscopic adrenaline injection and clip application. The patient re-presented on multiple occasions with bleeding recurrence localized to the duodenum, which was managed with intramuscular octreotide and oral beta-blockade resulting in sustained remission of bleeding. This case highlights a rare cause of upper gastrointestinal hemorrhage and highlights the value of somatostatin analogues for conservative treatment of DVs.

We report a case of a 72-year-old female with a past medical condition of non-alcoholic steatohepatitis who presented in the emergency department with altered mentation. An Esophagogastroduodenoscopy was performed which showed a normal esophagus and stomach, but revealed grade III varices which were appreciable in the second portion of the duodenum. Her colonoscopy report revealed multiple small and large mouthed diverticula in the sigmoid colon along with hematin throughout the colon, yet no evidence of active bleeding, mass or inflammation. We discuss the patient\'s rarity of the clinical entity, clinical development, and elements used for diagnosis along with the treatment modalities involved.

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Primary extra-hepatic portal vein obstruction (EHPVO) is a disease that develops ectopic varices due to portal hypertension and obstruction of the portal vein. Since bleeding from ectopic varices is life-threatening, the management of ectopic varices is important for patients with primary EHPVO. Here, we report a case of duodenal variceal bleeding in a patient with primary EHPVO. A 39-year-old man was diagnosed with F2-shaped duodenal varices (DV) due to primary EHPVO and was first treated with endoscopic variceal ligation for temporary hemostasis. We then performed angiography to understand the detailed hemodynamics and subsequently conducted endoscopic injection sclerotherapy (EIS) with a sclerosing agent containing N-butyl-2-cyanoacrylate for further hemostasis. After the treatment, dynamic computed tomography and endoscopic ultrasound revealed that the blood flow to the causative DV disappeared, although the DV itself remained. The patient was discharged without any re-bleeding or adverse events. Since treatment for DV due to primary EHPVO differs depending on hemodynamics (hepatofugal or hepatopetal blood flow), evaluating detailed hemodynamics for optimal treatment selection is crucial. Although EIS for this patient was not a radical treatment, it was effective in managing acute bleeding from the DV. This case will serve as a reference for successful treatment in future cases.

Ectopic variceal bleeding is an uncommon cause of gastrointestinal bleeding and carries a high mortality. Management depends on provider comfort and resource availability as treatment guidelines are lacking due to the infrequent occurrence of bleeding ectopic varices. We present a case of a middle-aged woman who presented with melena and anemia requiring transfusion. She was diagnosed with cirrhosis, and computed tomography of the abdomen revealed active bleeding at the proximal duodenum. She underwent emergent esophagogastroduodenoscopy, which showed actively bleeding duodenal varices secondary to portosystemic shunt from portal hypertension. Endoscopic hemostasis was achieved with variceal band ligation, a useful modality when alternative methods of emergent variceal management are unavailable. Given the risk of recurrent bleeding, the patient underwent embolization of varices by interventional radiology.