Abstract
A 54-year-old man with alcohol-related chronic pancreatitis presented with hematemesis and postural hypotension. His admission liver function biochemical tests were normal. After resuscitation he underwent an emergent EGD that revealed small esophageal and gastric fundic varices. A large amount of fresh blood and clots had pooled in the duodenum and active bleeding from an unknown source was observed. Endoscopic injection of adrenaline (total volume: 8 mL, 1:10,000 dilution) into the duodenal wall was performed for a presumptive ulcer-related UGI bleed. A second-look EGD 24 hours later confirmed a small duodenal ulcer without stigmata of recent bleed and non-bleeding duodenal varices in the second portion of the duodenum (A). Contrast-enhanced CT of the abdomen showed chronic pancreatitis with thrombosis of the main portal vein, splenic vein, superior mesenteric veins, and multiple collaterals (B). Linear echoendoscopy (model UCT180, EU-ME1 processor, Olympus, Tokyo, Japan) confirmed changes of chronic pancreatitis, multiple duodenal varices communicating with deeper extra-luminal collaterals, and a normal CBD.
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