Video capsule endoscopic appearance of small intestinal varices causing obscure gastrointestinal bleeding

Excerpt

A 53-year-old male, known case of decompensated cirrhosis of the liver with ascites, presented with a history of passing black-colored stool for two days prior to presentation. The patient underwent an upper gastrointestinal (GI) endoscopy, which showed small esophageal varices without any recent hemorrhage. Subsequent colonoscopy and triple-phase CT abdomen in view of ongoing melena could not localize the site of bleeding. In view of obscure overt GI bleeding, the patient underwent a video capsule endoscopy (VCE), which showed multiple ectopic varices throughout the small intestine, starting from the fourth part of the duodenum and involving the jejunum and ileum (Fig. 1). The patient was planned for a transjugular intra-hepatic portosystemic shunt procedure. However, in view of the non-affordability, the patient was continued on terlipressin infusion and blood transfusion, with the control of bleeding.

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