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 23 March 2018

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Recently bleeding esophageal varix.
A 72-year-old female with established cirrhotic primary biliary cirrhosis was admitted with hematemesis and melaena. Her initial BP was 90/40 and her hemoglobin concentration was 8.7g/dl. Following resuscitation, she was endoscoped with the finding of non-bleeding esophageal varices. There is a small firmly-adherent clot on the varix, indicating the site of her recent hemorrhage (2a). She was treated by endoscopic banding and was discharged 4 days later. Three weeks later she was admitted with a further massive hematemesis, when repeat endoscopy revealed gushing variceal bleeding (2b). Ulceration in the 12 o'clock position can be seen as a result of her previous banding. Following endoscopic sclerotherapy with ethanolamine oleate 5ml, hemostasis was secured (2c). She died 5 days later from liver failure.


Ken Matthewson, Newcastle upon Tyne, UK

Recently bleeding esophageal varix.

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