Downhill esophageal varices in a patient with recurrent hemodialysis permacath thrombosis

Abstract

A 31-year-old man with a history of type 1 diabetes mellitus and end-stage renal disease receiving hemodialysis via a right radiocephalic fistula presented with hematemesis and melena with hemodynamic instability requiring blood transfusion. He had a history of recurrent permacath thrombosis at different sites. The patient underwent upper endoscopy, which showed large esophageal varices in the upper esophagus, 1 with a “nipple” sign (A, white arrow) suggestive of recent bleeding. Endoscopic band ligation of the proximal varix was carried out with successful hemostasis.