Acute Bleeding due to a Esophagus Varix

This 65 year-old, diabetic lady, 3 days previously has been
hospitalized in another institution because of her first upper
GI bleeding manifesting with hematemesis and melena an
upper endoscopy displays esophageal varices; patient was
discharged from the hospital without specific therapeutical
treatment. She was referred to us to evaluate this
condition The patient was continued with intermittent
episodes of melena. A procedure of banding was planning,
at endoscopy a varix with an ulcer in the tip was found
(the white nipple sign). The site of bleeding was identified.

White ball appearance was a characteristic finding that appeared
after ligation of a varix at the site of bleeding. This finding may be
useful in the confirmation of successful ligation of a varix at its
bleeding site.
At the at the time of being exploring the stomach, the
patient present a cough reflex, causing rebleeding of the

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