Rare Cause of Gastric Varices Secondary To An Isolated Left Gastric Vein Stenosis - Rare Cause of Gastric Varices Secondary To An Isolated Left Gastric Vein Stenosis - Open Access Pub

A 69 year old female with a history of pancreatic mucinous cystadenoma (treated with Whipple procedure) and recently presumed liver cirrhosis presented to the hospital with melanotic stools. The source of the bleeding was initially thought to be secondary to upper gastrointestinal (GI) varices due to portal hypertension from the liver disease. Upper endoscopy found no active bleeding and confirmed grade 2 gastric varices with gastric wall edema. Due to persistent symptoms and inability to locate the exact source, she went to the operating room for possible transjugular intrahepatic portosystemic shunt (TIPS) but was not found to have any porto-systemic gradient. Instead, she was found to have an isolated stenosis of the left gastric vein, which was treated with balloon angioplasty and eventual splenectomy. Upper GI varices usually occur due to portal hypertension from liver disease. Extra hepatic causes are much rarer. We report a case of upper GI bleed from gastric varices secondary to left gastric vein stenosis rather than portal hypertension. The stenosis was due to a rare complication of a Whipple procedure. The case is unique as there are no reported cases of gastric varices secondary to left gastric vein stenosis. DOI10.14302/issn.2574-4526.jddd-16-1153 Upper GI varices are a common complication of portal hypertension 1. While they are usually associated with advanced liver disease, they can have extra hepatic causes. We present a case of a female with upper GI bleeding secondary to gastric varices as a result of an isolated left gastric vein stenosis. Case A 69 year old female with a history of pancreatic mucinous cystadenoma (treated with Whipple procedure) and recently presumed liver cirrhosis presented to the hospital with dizziness and melanotic stools. On presentation, she was hypotensive with a blood pressure of 85/50 mmHg and tachycardic with a heart rate of 115 beats per minute. Her physical exam was pertinent for pale skin, dry oral mucosa, and delayed capillary refill. Her complete blood count showed a hemoglobin level of 5.7 g/dL which was a significant drop from her baseline of 10 g/dL. Her liver functions tests and coagulation parameters were within normal limits. Computed tomography (CT) of the abdomen with contrast showed a mildly nodular liver and no signs of bleeding. She was resuscitated with blood transfusions and intravenous fluids. Her GI bleed was treated with octreotide and pantoprazole infusions. Gastroenterology specialists were consulted immediately. Patient was taken for an esophagogastroduodenoscopy (EGD) next morning