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| Hemorrhage from a spontaneously ruptured portal vein |
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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. |
