This patient experienced hemorrhage of esophageal varices as a result of alcoholic cirrhosis. EGD was not possible and tamponade with a Minnesota tube was unsuccessful. Hemostasis was finally achieved with an emergency TIPS procedure and embolization of varix.

Minnesota tubes are similar to Sengstaken-Blakemore tubes except that they feature a fourth lumen used to aspirate esophageal contents. Thus the four lumens are:

• gastric aspiration port
• esophageal aspiration port
• gastric balloon port
• esophageal balloon port

Case made with the help of Dr Jayanth Keshavamurthy, Medical College of Georgia, Augusta.