Presentation
Easy fatigability and abdominal distension. Hematological parameters demonstrated pancytopenia. Ultrasound revealed coarse liver echotexture, an enlarged spleen and dilated portal venous channels, suggestive of a chronic liver disease with portal hypertension.
Patient Data
CT demonstrates a massively enlarged spleen and extensively dilated portosplenic venous system with extensive shunting to the systemic circulation via the anterior abdominal wall, peri-umbilical, peri-vesicular, and retroperitoneal variceal venous channels. A recanalized dilated left umbilical vein is seen. A "georgian wig" appearance of peri-vesicular varices is seen.
Case Discussion
Vesical varices is a rare disease that may occur secondary to schistosomiasis and retroperitoneal fibrosis. It rarely occurs in patients with portal hypertension since the bladder wall is an unusual collateral route for venous splanchnic blood. They may appear when the usual splanchnic bed collaterals cannot develop which then directs the venous blood to flow through the venous system of the urinary bladder. Patients with vesical varices might present with gross hematuria.
Chronic liver disease leads to an increase in the porto-splenic venous axis pressures via multiple mechanisms, which result in an initial dilation of the venous channels draining into the portal system. Over time, this increase in the portal pressures leads to 'opening' of alternate pathways to relieve this pressure, which manifests as dilation and shunting of portal blood via various porto-systemic collaterals in retroperitoneal, upper rectal, perivesicular, periumbilical, perigastric regions, which manifest as varices in these regions.
Ascites and upper-gastrointestinal hemorrhage via these variceal dilations are frequently associated complications.
Unable to process the form. Check for errors and try again.