Transjugular intrahepatic portosystemic shunt and transcatheter embolization treatment of duodenal variceal bleeding

We present a case of a 53-year-old male with alcoholic cirrhosis who presented with acute hematemesis and hematochezia. The patient was initially treated with esophagogastroduodenoscopy guided band ligation of a large duodenal varix. Our interventional radiology department planned to treat this varix with balloon-occluded antegrade transvenous obliteration via a transhepatic approach. However, his hospital course was further complicated by decreasing hemoglobin and new hematochezia necessitated emergency transjugular intrahepatic portosystemic shunt (TIPS) placement. The patient underwent transcatheter embolization of the duodenal varices one day after the TIPS procedure due to recurrent bleeding. This case highlights the various decision points in the treatment algorithm for duodenal varices in the context of portal hypertension.