Bladder Varices Caused by Portal Hypertension

Abstract

This report presents a rare case of bladder varices caused by portal hypertension in a patient with no past history of surgery. The objective is to describe the diagnosis and management of such cases. A 63-year-old man with a 7-month history of intermittent painless gross hematuria and a 9-year history of hepatic cirrhosis was admitted to our hospital. Physical examination showed no abnormalities, lab tests revealed decreased platelets (56 × 10⁹/L), and ultrasound examination showed gross splenomegaly (5.8 cm thick, 14 cm long). On the left and front walls of his bladder, a network structure filled with blood was detected covering the area of approximately 7.0 × 2.4 cm. This structure stretched toward the outer upper quadrant of the left side of his bladder and connected with a large vein. Cystoscopic examination showed venous varices of about 3 × 5 cm in size in the left and front walls of his bladder. The CT and angiographic exams revealed that varicose vessels of the bladder were connected with the inferior mesenteric veins, and that blood from those vessels emptied into the portal veins. The patient was diagnosed with hepatic cirrhosis, portal hypertension, and vesicle venous varices. Perivesical devascularization was conducted. At the 1-month follow-up, varicose veins were no longer seen on the ultrasound exam. In conclusion, bladder varices can occur in patients with hepatic cirrhosis or portal hypertension with no previous history of surgery. In such patients, perivesical devacularization is a safe and effective treatment.