The Bleeding Duodenal Varix Dilemma: An Atypical Endoscopic Presentation of Duodenal Variceal Bleed

Cirrhosis is associated with various types of gastrointestinal bleeding, including variceal and nonvariceal. Among variceal bleeding, one of the rare causes is duodenal varices. We report a case of an atypical endoscopic presentation of a duodenal variceal bleed in a 66-year-old woman with metabolic dysfunction-associated steatohepatitis cirrhosis. Duodenal variceal bleeding can often mimic the Dieulafoy lesions, which can result in misdiagnosis, harmful interventions, and delayed treatment. This case underscores the importance on behalf of endoscopists to suspect broad differential diagnoses in patients with cirrhosis and atypical causes of gastrointestinal bleeding.