Identification and Management of Abdominal Wall Varices in Pregnancy.

BACKGROUND: Portal hypertension in pregnancy is associated with elevated risk of variceal hemorrhage. Ectopic varices, those located outside the esophagus or stomach, are rare but have a high risk of associated maternal morbidity or mortality. CASE: A 31-year-old woman, gravida 2 para 0010, with cirrhosis and portal hypertension was found to have abdominal wall ectopic varices on third-trimester obstetric ultrasonography. Computed tomography angiography confirmed these findings. Given concern for catastrophic hemorrhage during delivery, she underwent transjugular intrahepatic portosystemic shunt placement at 35 weeks of gestation, with reduction in the pressure gradient within the portosystemic circulation. She subsequently underwent an uncomplicated cesarean delivery. CONCLUSION: Identification of ectopic varices on obstetric ultrasonography may allow for treatment before delivery, decreasing the risk of serious maternal morbidity or mortality.

Duke Scholars

Author James Spencer Ronald Radiology

Author Waleska Michelle Pabon-Ramos Radiology, Interventional Radiology

Author Stuart Johnston Knechtle Surgery, Abdominal Transplant Surgery

Author Geoffrey D Rubin Radiology

Author Carla Wheaton Brady Medicine, Gastroenterology

Author Jennifer B Gilner Obstetrics and Gynecology, Maternal Fetal Medicine