Portal hypertensive hemorrhage from a left gastroepiploic vein caput medusa in an adhesed umbilical hernia.
Caput medusa is a frequent incidental finding in patients with portal hypertension that usually represents paraumbilical vein portosystemic collateral vessels draining into body wall systemic veins. A symptomatic caput medusa was seen in a morbidly obese patient after an umbilical hernia repair, which was fed not by the left portal vein but by the left gastroepiploic vein, in a recurrent adhesed umbilical hernia that likely contained herniated omentum. Refractory hemorrhage from this caput medusa was successfully treated by transjugular intrahepatic portosystemic shunt creation and balloon-occluded variceal sclerosis.
Sze
Daniel Y
DY
Division of Cardiovascular and Interventional Radiology, Stanford University Medical Center, California 94305-5642, USA. dansze@stanford.edu
Magsamen
Karl E
KE
McClenathan
James H
JH
Keeffe
Emmet B
EB
Dake
Michael D
MD
D006470:Hemorrhage / Q000209:etiology*; D006554:Hernia, Umbilical / Q000150:complications* / Q000601:surgery; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009829:Oleic Acids / Q000627:therapeutic use; D009852:Omentum / Q000473:pathology; D010532:Peritoneal Diseases / Q000209:etiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011183:Postoperative Complications; D012008:Recurrence; D012597:Sclerosing Solutions / Q000627:therapeutic use; D015911:Sclerotherapy; D013270:Stomach / Q000098:blood supply*; D000267:Tissue Adhesions / Q000150:complications; D014648:Varicose Veins / Q000209:etiology*
D009829:Oleic Acids; D012597:Sclerosing Solutions; C033343:ethanolamine oleate