Association of transjugular intrahepatic portosystemic shunt with embolization in the treatment of bleeding duodenal varix refractory to sclerotherapy. 
Bleeding from duodenal varices are often severe (mortality as high as 40%), and more difficult to sclerose than esophageal varices.  We report a patient with a bleeding duodenal varix, refractory to sclerotherapy, successfully treated by the association of portosystemic shunt placement and varix embolization, via the same transjugular intrahepatic route.  A 40-year-old Black male underwent emergency TIPS and duodenal varix embolization after failure of endoscopic sclerotherapy.  The portosystemic pressure gradient droped from 16 to 9 mm Hg following TIPS.  At 5 months from TIPS, the patient is well, with a patent shunt at Doppler ultrasound.  The present report of successful control of duodenal varix, actively bleeding and refractory to sclerotherapy, by means of combined TIPS and embolization, supports the role of TIPS and suggests that its association to embolization can be valuably considered in the difficult setting of portal hypertension with bleeding duodenal varices.