Rescue percutaneous transhepatic duodenal variceal embolisation followed by recanalisation of the portal and superior mesenteric veins in a pancreatic cancer patient experiencing massive variceal bleeding.

Occlusion of the portal system in pancreatic cancer patients occurs due to tumour invasion or compression, leading to segmental portal hypertension and the formation of portosystemic collaterals or varices at gastro-oesophageal or ectopic sites. Ectopic duodenal varices represent a rare and potentially life-threatening cause of upper gastrointestinal bleeding, associated with significantly high mortality rates. Herein, we describe a case of bleeding ectopic duodenal varices caused by occlusion of the splenoportal confluence, attributable to unresectable pancreatic cancer in a patient in his late 50s, who presented with multiple episodes of haematemesis and melaena over 3 days. This was successfully managed through variceal glue embolisation, followed by recanalisation of the portal system using a percutaneous transhepatic approach, after an unsuccessful endoscopic intervention. Endovascular recanalisation of the portal system through stent placement, along with ectopic variceal embolisation, may be considered a safe and effective alternative treatment option for managing ectopic varices in cases of inoperable pancreatic cancers with failed endoscopic treatment.