1. Large Gastro-esophageal Varices in Non-Cirrhotic

2. History 41 y/o Taiwanese–American physician
Hem consult – thrombocytopenia (30s)
HepB core +
Brothers and father HepB core +
Physical – splenomegaly

3. Laboratory Hgb: 14.9 Hct: 42.3 PLT: 34 WBC: 4.3 AST/ALT 25/16 TB 3
TP/Alb /4
Aphos 80
INR 1.3
AFP 20 Cr
Doppler US: all vessels patent (May 08)

4. Upper Endoscopy

6. Laparoscopy Images
Pathology: G-2 S-3

7. Clinical Course Prophylactic EV banding
One week later – gastric variceal bleed

8. Imaging Doppler US (July 08): Complete L-portal vein thrombosis
Partial main portal vein thrombosis
Complete thrombosis of SMV

9. Clinical Course
Patient underwent distal splenorenal shunt on 7/12/08