# Asymptomatic Extrahepatic Portal Venous Obstruction: A Case Report

## TL;DR

A 56-year-old woman with a history of cholecystectomy was diagnosed with extrahepatic portal venous obstruction and treated to prevent life-threatening bleeding.

## Contribution

This case highlights the importance of recognizing EHPVO as a potential cause of gastrointestinal bleeding and the need for better management guidelines.

## Key findings

- The patient had grade IV esophageal varices and other varices, indicating severe portal hypertension.
- EHPVO was diagnosed through MRI and endoscopy, with normal liver tissue observed.
- Endoscopic banding and beta blockers were used to prevent gastrointestinal bleeding.

## Abstract

This report describes a case of extrahepatic portal venous obstruction (EHPVO) with esophageal varices that would have led to significant bleeding if left untreated or inadequately managed. A 56-year-old diabetic and hypothyroid female visited our medical outpatient clinic to be assessed for pancytopenia and easy fatiguability. She experienced acute calculus cholecystitis 24 years ago, which was treated with a partial cholecystectomy. The laboratory tests showed indications of hypersplenism, characterized by anemia, leucopenia, and thrombocytopenia. The MRI results showed signs of long-term blockage of the portal vein outside the liver, with the liver tissue seeming normal. The upper gastrointestinal endoscopy showed grade IV esophageal varices, gastroesophageal varices 1, fundal varices, isolated gastric varices 2, and antral varices. The patient was diagnosed with EHPVO, and banding was performed as a preventive measure against upper gastrointestinal bleeding. Additionally, she was treated using conservative management techniques such as beta blockers. Endoscopic treatment is the standard of care for treating acute varices, while beta blockers are given as a secondary preventive measure. Despite cholelithiasis being a cause and/or sequelae to portal venous thrombosis, a clear explanation has not been offered to this patient while taking consent for cholecystectomy or thereafter. EHPVO is not frequently detected, and there is still a dearth of appropriate guidelines for managing this illness, even though it is a frequent cause of acute calculus cholecystitis and upper gastrointestinal bleeding.