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Figure 1. A 71-year-old woman with primary biliary cirrhosis had recurrent lower gastrointestinal bleeding requiring transfusions. At colonoscopic examination, large rectal varices were the only apparent source of bleeding (Panel A). A transjugular intrahepatic portosystemic shunt was inserted for portal decompression. The portoatrial pressure gradient subsequently fell from 28 mm Hg to 2 mm Hg. Angiography of the inferior mesenteric venous system (Panel B) revealed a dilated, tortuous inferior mesenteric vein (arrowhead), large rectal varices (straight arrow), and shunting of blood from the portal to the systemic circulation (curved arrow). Flexible sigmoidoscopy performed after portal decompression showed no evidence . . . [Full Text of this Article] |
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