Bleeding Esophageal Varices

Victor Navarro, M.D., and Adrian Reuben, M.B., B.S.

N Engl J Med 1994; 331:1129October 27, 1994

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Figure 1 Bleeding Esophageal Varices.

In an endoscopic photograph of the esophagus of a 56-year-old alcoholic man with massive hematemesis, blood can be seen spurting from a ruptured varix (arrow, Panel A). After injection sclerotherapy of the variceal trunk and immediate hemostasis, the source of bleeding was revealed as a white nipple, which represents what was thought to be a fibrin-platelet plug (arrow, Panel B). Endoscopic variceal ligation was performed for recurrent bleeding from the same source three weeks after the initial episode. The white object in Panel C (arrow) is the remnant of a banded varix.

Kim Eagle, M.D.

Victor Navarro, M.D.
Adrian Reuben, M.B., B.S.
Yale University School of Medicine, New Haven, CT 06510

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