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Published on Dec 22, 2011
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 varix.