Atlas of gastroenterological Endoscopy
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Hemorrhage from a spontaneously ruptured portal vein
Easily bleeding mucosa Blood shining through
A gastroscopy is performed for acute epigastric pain, a duodenal ulcer is diagnosed. Treatment with a proton pump inhibitor is succesful. Recurrent epigastric pain at day 8 initiates a second gastroscopy. The ulcer shows a normal process of healing. This time the bulbar mucosa is hemorrhagic (left). Distally the mucosal colour changes to a cyanotic blue (right image). During the following laparotomy a hemorrhage from the portal vein is diagnosed and treated. The ulcer is not adjacent to the portal vein, to explain the hemorrhage as side effect of gastroscpy is very unlikely. A medline search produces no published article of a ruptured portal vein after gastroscopy. Portal vein pressure seems to be normal in this patient, a trauma can be excluded. Thus, a spontaneous rupture of the portal vein has to be suspected.