Objective: To investigate the clinical features of regional portal hypertension (RPH) in children whose primary presentation was isolated gastric fundal varices. Methods: This case series study reviewed clinical data from 8 children diagnosed with RPH complicated with isolated gastric fundal varices at Beijing Children's Hospital, Capital Medical University from June 2017 to January 2026. Data on demographics, clinical manifestations, laboratory findings, diagnosis, and treatment were extracted and analyzed for etiology, clinical characteristics, and outcomes. Results: Among 8 children there were 6 males and 2 females, with a diagnostic age of 2.2-11.5 years. The underlying etiologies were pancreatic in 6 children (5 with severe pancreatitis complicated by pancreatic pseudocyst, and 1 with pancreatic involvement secondary to acute leukemia), all involving pancreatic body and tail. One child was of splenic origin (disseminated tuberculosis with splenic involvement), and 1 child was retroperitoneal (secondary to retroperitoneal neuroblastoma). Presenting features included abdominal pain (7 children), vomiting (6 children), and gastrointestinal bleeding (2 children, 1 of whom with isolated hematemesis, another 1 with hematemesis and melena). Splenomegaly occurred in 7 children. Ascites observed in 5 children, was attributed to the primary disease rather than to RPH. All 8 children had normal platelets, 3 children presented with leukopenia and anemia, which were attributed to the primary disease and secondary lesions. All 8 children had normal liver function, and coagulation function, but all demonstrated splenic vein abnormalities. All 8 children received treatment targeting at the underlying etiology. Somatostatin was administered to 5 children, and hemostatic agents to the 2 children with gastrointestinal bleeding. No child underwent endoscopic intervention. The follow-up ranged from 2 months to 8 years; 1 child with tuberculosis was lost to follow-up. The remaining 7 children showed symptomatic relief and improvement or complete resolution of gastric fundal varices. Conclusions: Regional portal hypertension often manifests as isolated gastric fundus varices and splenomegaly, and may be accompanied by gastrointestinal bleeding. Pancreatic, splenic, and retroperitoneal etiologies should be vigilanted. Individualized treatment strategies focused on the primary disease are crucial for improving pediatric RPH outcomes.

Gastric volvulus is an uncommon condition characterized by abnormal rotation of the stomach around one of its anatomical axes. Its diagnosis can be challenging because of its low incidence and nonspecific clinical presentation, particularly in elderly patients, and it may occur in association with a hiatal hernia. Delayed diagnosis may result in serious complications, including ischemia and perforation. Management should be individualized according to patient characteristics and surgical risk. We report the case of a 94-year-old woman with multiple comorbidities, including cardiovascular disease, chronic kidney disease, and long-term anticoagulant therapy, who presented with acute abdominal pain, abdominal distension, nausea, and hematemesis. CT revealed findings consistent with gastric volvulus without evidence of perforation. Given her elevated surgical risk, therapeutic endoscopy was performed, including gastric decompression, endoscopic reduction of the volvulus, and placement of a percutaneous endoscopic gastrostomy (PEG) for gastric fixation. The patient experienced immediate resolution of symptoms, with no procedure-related complications, and remained free of recurrence during 12 months of follow-up. This report highlights the successful use of endoscopic reduction followed by PEG as a long-term management strategy for gastric volvulus in a frail, high-risk surgical patient. It underscores the potential role of this minimally invasive approach in carefully selected patients who are not candidates for definitive surgical repair.

Bile duct injuries (BDI) after cholecystectomy often coexist with vascular injuries, but hepatic artery pseudoaneurysms may be missed on initial imaging. We report a right hepatic artery (RHA) pseudoaneurysm that manifested as haemobilia only after biliary decompression by Roux-en-Y hepaticojejunostomy for a Strasberg type E3 injury. A 28-year-old man presented 4 weeks after open cholecystectomy with obstructive jaundice. Magnetic resonance imaging confirmed a Strasberg type E3 stricture and identified a missed 8-mm RHA pseudoaneurysm. Following hepaticojejunostomy, haematemesis occurred on postoperative day 3. Computed tomography angiography demonstrated enlargement of the pseudoaneurysm to 12-mm with arteriobiliary communication. Covered stenting was followed by recurrent bleeding requiring glue-lipiodol embolization, complicated by non-target splenic embolization and an abscess requiring percutaneous drainage. The patient recovered and remained asymptomatic at three months. This case suggests that relief of biliary hypertension can unmask contained pseudoaneurysms and reinforces the importance of routine preoperative arterial-phase imaging in complex BDI.

This case report details the successful management of life-threatening gastric variceal bleeding in a female in her 60s with decompensated liver cirrhosis. The patient presented with hematemesis and hemorrhagic shock. After initial resuscitation, an esophagogastroduodenoscopy identified large gastric varices with signs of recent bleeding. A conventional transfemoral endovascular attempt to embolize the varix failed due to tortuous venous anatomy. Given the failure, an alternative approach was utilized by accessing a patent, recanalized umbilical vein. Under ultrasound guidance, this percutaneous transumbilical route provided direct access to the portal venous system. A catheter was successfully navigated to the coronary vein feeding the gastric varix, and embolization was performed using a liquid embolic system, achieving complete hemostasis. This case highlights the transumbilical approach as a safe and effective alternative for the endovascular treatment of bleeding gastric varices when traditional access is not feasible.

Thoracic aortic kinking, also known as pseudocoarctation of the aorta, is a rare congenital anomaly characterized by elongation and angulation of the aortic arch without significant luminal narrowing. We report the case of a 67-year-old man admitted for hematemesis and melena. CT pulmonary angiography performed during the diagnostic workup revealed a proximal right pulmonary embolism and an incidental marked angulation of the descending thoracic aorta at the level of the aortic isthmus, without evidence of stenosis or collateral circulation. In the absence of clinical and radiological features of true coarctation, the diagnosis of thoracic aortic kinking was established. Conservative management with clinical and radiological follow-up was adopted. This report highlights the importance of recognizing thoracic aortic kinking as a rare benign anomaly that may mimic true aortic coarctation and emphasizes the role of imaging in establishing the correct diagnosis and avoiding unnecessary intervention.

Gastric variceal bleeding is a rare but life-threatening complication of portal hypertension, posing significant management challenges during pregnancy. We report the case of a 25-year-old primigravida at 18 weeks of gestation who presented with hematemesis and melena. On examination, she was pale and tachycardic, with splenomegaly noted. Laboratory investigations revealed anemia and thrombocytopenia. Doppler ultrasound confirmed the presence of a portal cavernoma and splenomegaly. Upper gastrointestinal endoscopy showed large esophageal varices (EV) and fundal gastric varices (GOV2) with stigmata of recent bleeding, along with portal hypertensive gastropathy. Endoscopic management was carried out in two sessions. In the first session, cyanoacrylate glue injection achieved immediate hemostasis of the actively bleeding gastric varices. Forty-eight hours later, endoscopic variceal ligation was performed for the EV, resulting in complete obliteration. The patient remained stable postprocedure, with uneventful monitoring. Close multidisciplinary follow-up ensured favorable maternal and fetal outcomes. The pregnancy progressed without further complications, and at 39 weeks of gestation, the patient delivered a healthy baby via elective cesarean section. This case highlights the importance of early diagnosis, timely endoscopic intervention, and a coordinated multidisciplinary approach in the successful management of variceal bleeding during pregnancy.

Downhill esophageal varices are a rare cause of upper gastrointestinal bleeding and differ from distal esophageal varices associated with portal hypertension. They usually occur when obstruction of the superior vena cava (SVC) redirects venous flow through collateral pathways involving the esophageal venous plexus. We report the case of a 71-year-old man with a history of colon cancer in remission, status post partial colectomy with ostomy, who presented with recurrent hematemesis and dark stools. Upper gastrointestinal endoscopy showed large proximal esophageal varices consistent with downhill varices, and endoscopic band ligation was performed for bleeding control. Further evaluation with contrast-enhanced computed tomography of the chest demonstrated severe focal SVC stenosis in the setting of a long-standing indwelling chemotherapy port catheter, with catheter-associated thrombus and prominent collateral vessels. Interventional radiology removed the chemotherapy port catheter and performed balloon angioplasty/serial balloon dilation of the SVC stenosis up to 12 mm without stent placement during the index intervention, with improved venographic flow. This case highlights the importance of considering SVC obstruction when proximal esophageal varices are identified, especially in patients with a history of long-term central venous catheters or chemotherapy ports. Although endoscopic therapy can control acute bleeding, definitive management should address the underlying venous obstruction to reduce the risk of recurrence.

Obstructive jaundice is mostly caused by malignant lesions such as pancreatic head cancer and cholangiocarcinoma. Atypical benign conditions such as intramural duodenal hematoma (IDH), can imitate malignant processes in both clinical and radiological presentation. The diagnostic workup included computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS) with biopsy. A 65-year-old patient was referred for assessment of obstructive jaundice and endoscopic retrograde cholangiopancreatography (ERCP). Initial presentation included hematemesis, anemia, cholestasis, and coagulopathy. Imaging (MRCP, CT) showed dilation of intra- and extrahepatic bile ducts and pancreatic duct, suggesting obstruction at the pancreatic head. CT also revealed a heterogeneous mass in the duodenum. ERCP demonstrated duodenal stenosis due to external compression and distal bile duct narrowing, and a self-expandable metal stent (SEMS) was inserted. Endoscopic ultrasound with biopsy revealed an intramural duodenal hematoma without malignant features. The patient's medical history was significant for multiple comorbidities and previous anticoagulation therapy. Follow-up imaging demonstrated complete regression of the hematoma, confirming its benign nature. The observed clinical course was consistent with spontaneous resolution; consequently, there was no need for surgical intervention. Intramural duodenal hematoma is a rare but important condition that may mimic pancreatic head tumors causing obstructive jaundice. Early detection using imaging techniques is critical to accurately establish the diagnosis. Early recognition facilitates conservative treatment and helps avoid unnecessary highly invasive surgical procedures.