A Case of Refractory Gastric Hemorrhage Due to Portal Hypertensive Gastropathy Successfully Treated with Distal Gastrectomy

Abstract

A 71-year-old male with alcoholic liver cirrhosis complained of melena during systemic chemotherapy for hepatocellular carcinoma. Upper gastrointestinal endoscopy revealed venous bleeding from an erosion in the gastric pylorus. Abdominal contrast-enhanced CT and angiography revealed tumor thrombosis in the main portal vein and collateral vessels of the lesser omentum, which we diagnosed as portal hypertensive gastropathy (PHG). Endoscopic hemostasis did not completely stop the bleeding and frequent blood transfusions were required. The esophageal/gastric varices were not highly developed and did not bleed; the bleeding site was located in the gastric pylorus. Thus, distal gastrectomy was performed. We maximally preserved the collateral vessels to maintain hemodynamics. Bleeding did not recur in the 6-month period following the operation. This is the first report of successful use of distal gastrectomy to treat refractory gastric hemorrhage in a patient with PHG.