# Ultrarapid Development of Ruptured Esophageal Varices in a Patient With a History of Heller Myotomy

## TL;DR

A patient with no recent signs of esophageal varices experienced a sudden rupture, highlighting the unpredictable nature of this condition.

## Contribution

This case report highlights an unusual and rapid development of ruptured esophageal varices despite recent negative endoscopic findings.

## Key findings

- A patient with no recent varices on endoscopy developed life-threatening variceal hemorrhage within a month.
- This case challenges the assumption that regular surveillance intervals are sufficient to prevent sudden variceal rupture.
- It suggests the need for closer monitoring in certain high-risk patients.

## Abstract

Esophageal varices commonly affect cirrhotic patients as a result of elevated portal system resistance. Blood pools within esophageal portosystemic collateral vessels, which can eventually rupture, leading to life-threatening hemorrhage. To prevent this, cirrhotic patients without a history of varices undergo endoscopic surveillance for varices every 2-3 years. We present an unusual case of variceal hemorrhage in a patient who was seen to have no varices on endoscopic evaluation only a month earlier.