Abstract
Upper gastrointestinal (GI) bleedings of esophageal or gastric varices occur in the settings of portal hypertension due to well-known porto-systemic shunts. In this communication we report a previously unrecognized pathophysiological mechanism of gastric varices formation, via spontaneous reno-gastric shunt, as a result of Inferior Vena Cava (IVC) hypertension, rather than portal hypertension. We report a case of 54 years old male with severe chronic congestive heart failure and bleeding gastric varices. Cardiac cirrhosis was initially suspected as a cause for his condition. However, direct venography measurements showed high central venous and portal pressures without significant porto-systemic gradient, and hepatopetal flow direction from the IVC though left renal vein and via spontaneous reno-gastric shunt towards gastric varices. This paradoxical cavo-portal, collateralization pathway should be considered in differential diagnosis of upper GI bleeding in patients with severe congestive heart failure, it can be diagnosed by venography and treated by trans-caval embolization.
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