Alcoholic liver cirrhosis complicated by duodenal and small intestinal variceal rupture recurrent bleeding: a case report of unusual ectopic varices.

Background: Small intestine varicose vein is a common ectopic varicose vein of digestive tract. Duodenum is the most bleeding ectopic varicose vein. The possible clinical manifestations include black stool and blood in stool. Because of the special location of ectopic varicose veins, it is difficult to detect early in clinic. This patient has multi-site varicose veins, and the treatment process is tortuous, combined treatment of medicine and surgery. Case Description: This case report presents a 58-year-old male with alcoholic liver cirrhosis, with black stools as the main clinical manifestation. There is a history of abdominal surgeries such as splenectomy in the past. Through gastroscopy, enteroscopy, and other examinations, multiple ectopic varicose veins in the duodenum and jejunum were found. After conventional endoscopic treatment, there was still active bleeding. Later, combined surgical treatment successfully stopped the bleeding. The patient no longer had black stools and was discharged from the hospital after his condition improved. Conclusions: Ectopic varicose veins are an important complication of portal hypertension. Clinical awareness of the possible presence of ectopic varicose veins is essential for early detection and management in patients with gastrointestinal bleeding whose source is uncertain. Clinically, the understanding of ectopic varicose vein rupture and bleeding should be enhanced. A clear diagnosis can be made through enteroscopy. In terms of treatment, the first consideration should be to reduce portal pressure. Simple endoscopic treatment may have a poor effect. Relevant risk factors can be studied to conduct primary prevention for high-risk patients in advance.