Case Report
 
A rare cause of obscure upper gastrointestinal bleeding: A challenging experience
Khalid Y. Nabrawi1, Saad S. Algahtani2, Ahmed Y. Shaheen1, Abdullah M. Alshehri1, Mushabab Algahtani1, Mohamed-Elbagir K. Ahmed3
1Department of Medicine, Gastroenterology Unit, Aseer Central Hospital, P O Box 34, Abha, Saudi Arabia
2Department of Interventional Radiology, Armed Forces Hospital, Southern Region, P O Box 101, Khamis Mushait, Saudi Arabia
3Department of Medicine, College of Medicine, King Khalid University, P O box 641, Abha, Saudi Arabia

Article ID: Z01201801CR10870KN
doi: 10.5348/ijcri-201801-CR-10870

Corresponding Author:
Professor Mohamed Elbagir K. Ahmed,
Department of Medicine, College of Medicine,
King Khalid University, P O Box 641,
Abha 61421,
Saudi Arabia

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How to cite this article
Nabrawi KY, Algahtani SS, Shaheen AY, Alshehri AM, Algahtani M, Mohamed-Elbagir KA. A rare cause of obscure upper gastrointestinal bleeding: A challenging experience. Int J Case Rep Images 2018;9(1):16–19.


ABSTRACT

Introduction: Liver cirrhosis leads to a serious complication mainly the development of portal hypertension which causes catastrophic consequences namely variceal bleeding, encephalopathy, and hepatocellular carcinoma. Bleeding is commonly caused by ruptured esophageal, gastric, and rarely ectopic varices. We report here a patient with liver cirrhosis who presented with obscure upper gastrointestinal bleeding proved to be due to an ectopic varix.
Case Report: Our patient is a 55-year-old known hepatitis C virus related cirrhotic man who presented with recurrent melena and hematochezia without abdominal pain. Physical examination was remarkable for pallor, jaundice, and ascites. Following resuscitation, upper endoscopy showed non-bleeding esophageal varices and colonoscopy was unremarkable. Further workup with CT angiography revealed the presence of sub mucosal varix at the level of a small bowel jejunal loop. This was successfully embolized by coiling under ultrasound guidance by the interventional radiologist.
Conclusion: This report refreshes the minds about the proper diagnosis and management of obscure upper gastrointestinal bleeding caused by ectopic varices and emphasizes the important role of the interventional radiologist in this matter.

Keywords: Ectopic varix, Gastrointestinal bleeding, Interventional radiology


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Author Contributions
Khalid Y. Nabrawi – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Saad S. Algahtani – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ahmed Y. Shaheen – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Abdullah M. Alshehri – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mushabab Algahtani – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Mohamed-Elbagir K. Ahmed – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Khalid Y. Nabrawi et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.