doiSerbia

Not so innocent bystander - gallbladder varices without portal vein thrombosis

Milovanović Tamara (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia), tamara.alempijevic@med.bg.ac.rs
Dumić Igor (Mayo Clinic College of Medicine and Science, Rochester, MN, USA)
Ilić Ivana (Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia)
Baralić Marko (Clinical Center of Serbia, Clinic for Nephrology, Belgrade, Serbia)
Dragašević Sanja (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia)
Stojković-Lalošević Milica (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Center of Serbia, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia)
Arsenijević Vladimir (University of Belgrade, Faculty of Medicine, Belgrade, Serbia + Clinical Centre of Serbia, Emergency Center, Department of Emergency Surgery, Belgrade, Serbia)

Introduction. Gallbladder varices (GBV) represent a rare form of ectopic varices that usually occur in patients with portal hypertension and portal vein thrombosis. Case outline. We present a case of a 38-year-old woman with decompensated autoimmune liver cirrhosis who was referred to our institution for evaluation for liver transplantation. She was incidentally discovered to have GBV during a routine B-mode abdominal ultrasonography as part of pre-transplant evaluation. GBV were confirmed by the Color Doppler Sonography, and multi detector computed tomography angiography. Interestingly, portal vein was patent and without thrombus. Conclusion. Despite being asymptomatic in most cases, the presence of GBV is valuable information for a surgeon because they might be a source of potentially catastrophic bleeding, which is particularly poorly tolerated by patients with decompensated liver cirrhosis. Ultrasound has the irreplaceable role not only in discovering GBV, but in prompt diagnosis of rare, but unpredictable and fatal complications as well.

Keywords: gallbladder varices, ectopic varices, portal hypertension