Torrential upper gastrointestinal bleeding from 'downhill' oesophageal varices complicating long term central venous access for total parenteral nutrition.

Oesophageal varices usually develop in the setting of portal hypertension secondary to chronic liver disease. However, superior vena cava (SVC) obstruction can result in 'downhill' varices forming in the upper oesophagus. A case of torrential upper gastrointestinal bleeding from SVC obstruction due to chronic central venous access for home total parenteral nutrition is described. It is suggested that in patients presenting with gastrointestinal bleeding in the setting of SVC obstruction, 'downhill' varices should be suspected. The current literature is discussed regarding management of such varices. It is recommended that endoscopic variceal surveillance be carried out in patients with known SVC obstruction.