A case of congenital porto-systemic shunt diagnosed on the occasion of ruptured gastric varices

Abstract

An 18-year-old man was admitted to our hospital due to sudden melena. Abdominal computed tomography showed splenomegaly, developed collateral vein, and gastroesophageal varices. Emergency upper endoscopy showed red plaque on gastric cardial varices without active bleeding. The injection of 67% NBCA (n-butyl-2-cyanoacrylate: Histacryl^®) was performed in the vicinity of the red plaque. Finally, we diagnosed the case as congenital porto-systemic shunt (CPS) by intravenous balloon occluded portography, abdominal angiography, and liver biopsy. The patient was discharged after two sessions of endoscopic injection therapy to the esophageal varices. To our knowledge, this is the first report of CPS diagnosed with ruptured gastric varices.