Bleeding Gastric Varices
46 year-old man with no documented liver disease, presented with massive upper gastrointestinal bleeding. Endoscopy revealed spurting from a large varix in the gastric fundus (left), seen on retroflexed view. Hemostasis was achieved by the endoscopic application of a rubber band at the site of bleeding (right).
Left: 56 year-old man was hospitalized with upper gastrointestinal tract bleeding, in hemorrhagic shock, and in a near-comatose state. Initial endoscopy, prior to volume repletion, demonstrated no active bleeding, and no varices were visible. Bleeding recurred several days after circulating volume had been restored with transfusions and volume infusions. At that time, endoscopy demonstrated massive bleeding from this distended varix in the gastric fundus. Endoscopic rubber-banding effectively controlled the bleeding.
Center: 55 year-old man with alcoholic cirrhosis who presented with massive hematemesis (vomiting blood). Active pulsatile bleeding from a gastric fundic varix was seen at endoscopy. Bleeding was successfully controlled by the endoscopic placement of a band at the bleeding site.
Right: 48 year-old man with cirrhosis, presented in hemorrhagic shock. Endoscopy demonstrated an actively bleeding varix in the gastric cardia, with a continuous flow of blood. Hemostasis was achieved at endoscopy by banding.
Left: Jet of blood (flowing from upper right to lower left) from a varix in the gastric cardia of a 50 year-old man with alcoholic cirrhosis who had presented with acute hematemesis and melena. Right: Hemostasis was achieved by the application of a band to the point of bleeding.
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