Distal Duodenal Varices: First Presentation of Upper Gastrointestinal Bleeding.

Varices are abnormal dilated veins which result from increased pressure in the portal circulation. Although the oesophagus and stomach are the most common sites for varices to develop, they may also occur as ectopic varices in the duodenum, rectum, and retroperitoneal areas. Isolated duodenal varices involving distal duodenum, particularly the fourth part of the duodenum, are extremely rare. However, such ectopic varices are associated with an increased risk of bleeding and mortality. Not only are they a diagnostic challenge, particularly if they present as a first manifestation of portal hypertension, they are also very difficult to treat due to their location. We present an interesting case of upper gastrointestinal bleeding where ectopic varices in the fourth part of the duodenum presented as a first manifestation of upper gastrointestinal bleeding. Gastroscopy did not reveal the source of bleeding and thus CT angiogram was performed in order to confirm the diagnosis. Radiological intervention by embolisation resulted in successful treatment.