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.

An 83-year-old man was admitted to the emergency department of our hospital with a chief complaint of melena. A computed tomography revealed a hypervascular tumor approximately 3 cm in size near the duodenojejunal flexure. On diagnosis of bleeding from the gastrointestinal stromal tumor (GST), emergency surgery was performed. At laparotomy, a whitish tumor measuring approximately 3 cm in diameter was identified on the serosal surface along the mesenteric border of the duodenojejunal flexure. Considering the need for secure hemostasis, a segmental duodenectomy including resection of the feeding vessels to the affected bowel segment was performed. For reconstruction, considering that anastomosis posterior to the superior mesenteric artery (SMA) was avoided and instead performed primary closure of the duodenal stump. To provide duodenal drainage, a Roux-en-Y jejunal limb was constructed and anastomosed to the 2[nd] part of the duodenum. Additionally, a gastrojejunostomy in the Billroth II configuration was performed. The patient was discharged on postoperative day 15, with no complications.

Radiation-induced hemorrhagic gastroduodenitis is an intractable and potentially life-threatening condition. This study reports the case of a 57-year-old male with radiation-induced hemorrhagic gastroduodenitis. The patient had previously received radiotherapy for metastatic tumors involving the liver and adrenal gland. Following this treatment, he presented with melena and anemia, necessitating hospital admission. Prior therapeutic efforts included epinephrine spraying in the gastric antrum and embolization of the gastroduodenal artery. Despite these measures, along with multiple transfusions of packed red blood cells, the hemorrhage persisted. Ultimately, oral administration of thalidomide successfully controlled the bleeding. This case indicates that oral thalidomide may represent a potential treatment option for severe radiation-induced hemorrhagic gastroduodenitis.

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.

Extraosseous Ewing sarcoma (ES) is a rare malignant tumor with poor prognosis. ES of pancreatic origin is exceedingly rare, with only a few dozen cases documented in the literature. It is a poorly differentiated, aggressive tumor characterized by multiple recurrences and a relatively poor prognosis. Owing to nonspecific imaging findings, it can easily be misdiagnosed as other tumors. Here, we report a case of primary pancreatic ES with direct gastric invasion in a 63-year-old male who presented with melena and summarize previously reported cases of primary pancreatic ES. Radiologists should be aware of the imaging findings of primary pancreatic ES and understand that it may be clinically confused with other tumors because of overlapping imaging features.

Penetrating spine injuries associated with abdominal and thoracic injuries caused by steel bars are rare. We report a unique case of delayed spinal spondylitis after penetrating abdominal and thoracic injuries from multiple steel bars. A 65-year-old man fell from a 20-m high scaffolding onto vertical steel bars. Steel bars penetrated his scrotum, abdomen, thoracic cavity, thigh, calf, and left ankle. At the accident scene, a fellow worker removed multiple penetrating bars. The first operation included repairs to the liver, diaphragm, transverse colon, sigmoid colon, jejunum, scrotum, and the pelvic wound, as well as open reduction and internal fixation of the left ankle. In a second operation, surgeons resected the sigmoid colon with anastomosis, and then sutured and debrided the peritoneum, mesentery, and the right thigh and calf wounds. The patient complained of anorexia and melena a month and a half after the trauma. Chest computed tomography 57 days after the trauma demonstrated pyogenic spondylitis in the thoracic spine. Culture of a perivertebral abscess 2 months after trauma revealed Pseudomonas aeruginosa. Antibiotic treatment resolved the pyogenic spondylitis. High clinical suspicion and awareness of delayed pyogenic spondylitis support early diagnosis and improve outcomes when appropriate treatment is given.