When a Bulbar Ulcer Hides a Darker Reality: The Unusual Diagnosis of a Portal Cavernoma in a 69‐Year‐Old Adult

Abstract

ABSTRACT A portal cavernoma is a network formed by localized dilation of the hepatic portal system. This study aims to describe a case of portal cavernoma in a 69‐year‐old adult presenting with gastrointestinal hemorrhage. This is a 69‐year‐old patient with no particular medical history admitted for hematemesis associated with diffuse abdominal pain. Clinical examination revealed blood pressure of 100/60 mmHg and tenderness in the epigastric region. Upper gastrointestinal endoscopy revealed a large bulbar ulcer in flare‐up. Helicobacter pylori testing in stool samples was positive. The initial diagnosis was a bulbar ulcer, and the patient was placed on treatment to eradicate H. pylori . However, an abdominal ultrasound performed later suggested heterogeneous portal vein thrombosis, which was confirmed by abdominal CT scan. Given these findings, we made a diagnosis of portal cavernoma revealed by gastrointestinal hemorrhage. Treatment consisted of 40 mg of injectable omeprazole every 12 h, 40 mg of propranolol per day, and one sachet of Gaviscon every 8 h. Anticoagulation was initiated with enoxaparin and then continued with 4 mg of acenocoumarol per day. The patient responded well to treatment, with regression of abdominal pain and gastrointestinal hemorrhage, and was discharged home after 10 days following two stable INR readings. Although most commonly described in pediatrics, this clinical case sheds light on adult forms of the disease.