Duodenal variceal bleeding--successfully treated by mesocaval shunt after failure of sclerotherapy.

A 68-year-old male patient with liver cirrhosis and bilateral diffuse hepatoma presented with massive upper gastrointestinal bleeding caused by rupture of duodenal varices. Surgery had to be performed after sclerotherapy failed to stop the bleeding. A mesocaval shunt with graft interposition controlled the hemorrhage. Follow-up endoscopic examination showed complete disappearance of the varices. After surgery, the patient had two episodes of mild hepatic encephalopathy, which easily responded to treatment. There was no rebleeding, and he died of hepatic malignancy ten months after the shunt procedure.