Images in Clinical Medicine

Bleeding Angiodysplasia in the Duodenum

Kuang-I Fu, M.D., and Takahiro Fujimori, M.D., Ph.D.

N Engl J Med 2006; 354:283January 19, 2006

• Slide

Article

An 86-year-old woman with cirrhosis and esophageal varices due to chronic hepatitis C infection was referred for evaluation of anemia and fatigue. Esophagogastroduodenoscopy revealed active bleeding in the third part of the duodenum (Panel A). After the area was washed with water, angiodysplasia with a bleeding vessel was revealed (Panel B, arrow). Before argon plasma coagulation was performed, submucosal saline solution was injected to minimize the thermal injury and prevent perforation (Panel C, arrow). The bleeding was successfully controlled (Panel D). At one year of follow-up, the patient has had no recurrence of bleeding or anemia.

Kuang-I Fu, M.D.
Takahiro Fujimori, M.D., Ph.D.
Dokkyo University School of Medicine, Tochigi 321-0293, Japan