Year 2024 / Volume 116 / Number 5
Letter
Ectopic variceal bleeding secondary to porto-sinusoidal vascular disease

287-288

DOI: 10.17235/reed.2023.9683/2023

Ángela Antón RodrÍguez, Ángela María Puente Sánchez, José Ignacio Fortea, Aitor Odriozola Herrán, Víctor José Echavarría Rodríguez, Sara Alonso Fernández, Elena Montano Lumbreras,

Abstract
Porto-sinusoidal vascular disease (PSVD) is an uncommon cause of portal hypertension (PHT) characterized by typical manifestations of PHT in the absence of an identifiable cause such as cirrhosis or splenoportal thrombosis. There are different etiological factors, including oxaliplatin. We present the case of a 67-year-old male with a history of locally advanced rectal cancer in 2007 treated with chemotherapy (capecitabine, folinic acid, 5-fluorouracil and oxaliplatin), radiotherapy and surgery with a definitive colostomy. He was admitted for lower gastrointestinal bleeding from the colostomy with no anemia or hemodynamic repercussion. Colonoscopy was performed and no lesions were found. Abdominal computed tomography (CT) showed peristomal varices with porto-systemic collaterals at that level. There was splenomegaly, no evidence of chronic liver disease and the splenoportal axis was permeable. Laboratory tests showed chronic thrombocytopenia. Laboratory results excluded other causes of liver disease, hepatic elastography showed a value of 7.2 kPa and upper gastrointestinal endoscopy ruled out esophagogastric varices. The catheterisation of hepatic veins demonstrated a hepatic venous pressure gradient of 13.5 mmHg and liver biopsy revealed sinusoidal dilatation with sinusoidal and perivenular fibrosis. Because of the clinical context of the patient with a history of treatment with oxaliplatin, he was diagnosed with peristomal ectopic varices secondary to porto-sinusoidal vascular disease. Due to bleeding recurrence, it was finally decided to place a transjugular intrahepatic portosystemic shunt (TIPS).
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References
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Citation tools
Antón RodrÍguez Á, Puente Sánchez Á, Fortea J, Odriozola Herrán A, Echavarría Rodríguez V, Alonso Fernández S, et all. Ectopic variceal bleeding secondary to porto-sinusoidal vascular disease. 9683/2023


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Publication history

Received: 20/04/2023

Accepted: 03/05/2023

Online First: 14/06/2023

Published: 09/05/2024

Article Online First time: 55 days

Article editing time: 385 days


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