Abstract
The white nipple sign is a term used to describe a fresh fibrin clot on a varix that has bled recently. The authors describe a case to highlight the importance of prompt endo-therapy when this sign is recognised as disturbing this clot can cause brisk bleeding
A 63-year-old lady with acute alcoholic hepatitis was admitted with haematemesis. Emergency gastroscopy revealed the presence of ‘white nipple sign’: fresh platelet fibrin clot at the site of recent variceal haemorrhage. She underwent immediate endoscopic band ligation and haemostasis was achieved after transient bleeding. The white nipple sign is specific for recent variceal haemorrhage and is likely to be encountered when endoscopy is performed early and has no prognostic significance. Endoscopists must familiarise themselves with this sign and, on recognising this finding, the emphasis should be on immediate banding as clot destabilisation will cause brisk bleeding.
Figure 1.
White nipple at 5.0' clock and postbanding appearance.
Footnotes
Contributors: RK: drafting the manuscript and literature review. NP: drafting the manuscript and literature review.CL: consultant supervisor and endoscopist involved in this case.
Competing interests: None.
Patient consent: Obtained.
Provenance and peer review: Not commissioned; externally peer reviewed.