Published online Jul 7, 2014. doi: 10.3748/wjg.v20.i25.8292
Revised: March 2, 2014
Accepted: April 5, 2014
Published online: July 7, 2014
Bleeding from gastro-esophageal varices can often present as the first decompensating event in patients with cirrhosis. This can be a potentially life threatening event associated with a 15%-20% early mortality. We present a rare case of new onset ascites due to intra-abdominal hemorrhage from ruptured mesenteric varices; in a 37 years old male with newly diagnosed nonalcoholic steatohepatitis induced cirrhosis as the first decompensating event. The patient was successfully resuscitated with emergent evacuation of ascites for diagnosis, identification and control of bleeding mesenteric varices and eventually orthotopic liver transplantation with successful outcome. Various clinical presentations, available treatment options and outcomes of ectopic variceal bleeding are discussed in this report.
Core tip: Nonalcoholic steatohepatitis (NASH) related cirrhosis of the liver is an emerging disease. With the advent of new therapies for hepatitis C and the potential for cure, NASH will most likely be the leading cause of decompensated liver disease in the future. We present a rare case of hemorrhagic ascites from ectopic variceal rupture as the initial decompensating event in a young patient with a recent diagnosis of cirrhosis from NASH. A multidisciplinary, methodical treatment plan was undertaken, culminating in orthotopic liver transplantation and successful outcome. We briefly discuss presentation, diagnosis and management of ectopic variceal bleeding, which is not so commonly encountered in routine clinical practice in this case report.