When to avoid glue injection of varices - A case of radiology guided embolization of bleeding ectopic duodenal varices

Isolated duodenal variceal hemorrhage is rare and has a high mortality rate, but the diagnosis and treatment can be challenging. We describe a case in which endoscopic variceal injection was deemed too high risk and not feasible due to patient factors of rapid blood flow and an unstable scope position. Eventually, an interventional radiology (IR) based embolization technique, using a combination of coils and glue, was successful in achieving hemostasis. This case presents an alternative strategy for clinicians in managing duodenal variceal bleeding.