Portal hypertensive gastropathy, enteropathy, and colopathy

Case contributed by Dr Michael P Hartung


Abdominal pain and gastrointestinal bleeding on a background of cirrhosis

Patient Data

Age: 55 years
Gender: Male

There is cirrhosis, abdominal varices, and a medium amount of ascites. The spleen is surgically absent. The stomach, small bowel, and colon are diffusely abnormal. The stomach demonstrates thickened rugal folds with increased enhancement, the small bowel is diffusely thickened and hyperenhancing while the colon thickened with submucosal edema (low attenuation of the walls between the mucosa and serosa) with mucosal hyperenhancement. 

Case Discussion

Portal hypertensive gastropathy, enteropathy, and colopathy results from chronic venous congestion and the formation of mucosal and submucosal varices in the gastrointestinal tract. This can result in acute or chronic gastrointestinal bleeding due to mucosal friability. The first line treatment is non-selective beta-blockers and iron supplementation. 

This is a very dramatic case demonstrating all of the findings of portal hypertensive enteropathy in a single scan. Such diffuse involvement would not be typical. However, it may be that because the spleen is absent, this patient would be more likely to have congested venous blood divert into submucosal varices throughout the bowel. It would also be possible that a superimposed inflammatory or infectious gastroenteritis could further exacerbate this appearance on imaging. 

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