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Spurting Rectal Varix

Open AccessPublished:October 14, 2021DOI:https://doi.org/10.1016/j.gastha.2021.10.004
      A 70-year-old male with a history of hepatitis C and alcohol abuse was brought to the emergency department via emergency services with hematochezia. The patient was found to be hypotensive in route and was given blood products. After initial improvement, the patient was actively bleeding and became hypotensive again. He was then transferred to the intensive care unit, and rapid transfusion protocol was initiated. Vasopressors were started. Hematocrit on I-STAT was 21, and hemoglobin resulted at 8.1. Because of continued bleeding, the nasogastric tube was put in; however, there was no blood on return. The patient was also intubated at that time.
      Upper endoscopy: The normal esophagus with no varices, pale gastric mucosa with small nonbleeding erosions and some hematin, and normal first and second part of the duodenum were found.
      Sigmoidoscopy: The perianal examination showed evacuation of active large clots and bright red blood. Blood and a large, bleeding rectal varix were found (Figure A). One band was successfully placed (Figures B and C), and no further bleeding was noted (Figure D).
      The patient continued to be resuscitated and was taken to interventional radiology for embolization of the rectal varix. Unfortunately, the patient had worsening renal failure with hyperkalemia requiring renal replacement therapy and continued to clinically worsen. The patient passed away the next day.