Hepatobiliary and Pancreatic: Bleeding duodenal varices.

摘要

A young woman, aged 19, presented to the Emergency Department with abdominal pain and gastrointestinal bleeding. Pain had been present for 4 days and, on the day of admission, she had episodes of nausea and vomiting. Subsequently, she began to vomit blood and also developed melena. She had been previously diagnosed with a hypercoagulable state resulting from a JAK-2 mutation and was known to have portal vein thrombosis with extension of the thrombosis into the splenic and superior mesenteric veins. She had also been previously diagnosed with esophageal varices but had not had episodes of gastrointestinal bleeding. She ceased treatment with warfarin 1 month prior to admission but restarted the drug after the onset of abdominal pain. Blood tests revealed a hemoglobin of 7.6 g/dL (76 g/1) with an international normalized ratio (INR) of 2.1. After fluid resuscitation and the correction of coagu-lopathy, upper gastrointestinal endoscopy was performed.