An Unusual Cause of Recurrent Upper Gastrointestinal Bleeding: Duodenal Varices in Portal Hypertension

Duodenal varices are an uncommon cause of upper gastrointestinal bleeding in patients with portal hypertension and may be overlooked during endoscopic evaluation. We report the case of a 44-year-old woman with portal hypertension secondary to alcohol-related chronic liver disease who presented with recurrent upper gastrointestinal bleeding manifested by hematemesis and melena. Emergency upper gastrointestinal endoscopy revealed three duodenal varices located in the duodenal bulb, one of which showed an adherent platelet-fibrin clot with active bleeding, while only a small gastroesophageal varix without high-risk stigmata was observed on retroflexion. Endoscopic band ligation of the bleeding duodenal varix was successfully performed, achieving immediate hemostasis without complications. The patient remained clinically stable with no recurrence of bleeding and was discharged on secondary prophylaxis. This case highlights duodenal varices as a rare but potentially life-threatening source of gastrointestinal bleeding and emphasizes the importance of careful endoscopic examination in patients with portal hypertension.