Duodenal variceal bleeding with large spontaneous portosystemic shunt treated with transjugular intrahepatic portosystemic shunt and embolization: A case report

BACKGROUND: Duodenal variceal bleeding is a rare cause of gastrointestinal bleeding. The most common site is the duodenal bulb. It is usually detected endoscopically but it can be very challenging to diagnose if it is located distal to the second part od duodenum. The pre- transjugular intrahepatic portosystemic shunt (TIPS) presence of spontaneous portosystemic shunt (SPSS) was found to be associated with an increased risk of early morbidity and mortality after TIPS placement. CASE SUMMARY: the left gonadal vein. Thrombectomy and TIPS shunt balloon angioplasty was performed, followed by embolization of the portosystemic. The melena was resolved, and patient was discharged with arranged hepatology follow up. CONCLUSION: It importance to look and embolize the SPSS shunts in patients with early TIPS dysfunction and recurrent duodenal variceal bleeding.