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 (a). 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 (b).
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 (c). She died 5 days later from liver
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