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Year : 2021  |  Volume : 2  |  Issue : 3  |  Page : 250-251

Caput medusae in a patient with non-cirrhotic portal fibrosis: Clinical images

Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, New Delhi, India

Date of Submission16-Oct-2021
Date of Decision05-Nov-2021
Date of Acceptance06-Nov-2021
Date of Web Publication28-Dec-2021

Correspondence Address:
Dr. Neha Sharma
Room No: 1469, Sir Ganga Ram Hospital, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JME.JME_97_21

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How to cite this article:
Sharma N, Ray S, Nundy S. Caput medusae in a patient with non-cirrhotic portal fibrosis: Clinical images. J Med Evid 2021;2:250-1

How to cite this URL:
Sharma N, Ray S, Nundy S. Caput medusae in a patient with non-cirrhotic portal fibrosis: Clinical images. J Med Evid [serial online] 2021 [cited 2022 Aug 7];2:250-1. Available from: http://www.journaljme.org/text.asp?2021/2/3/250/333963

Varices are distended tortuous veins which occur in patients with portal hypertension at the sites of anastomosis between the high-pressure portal venous tributaries and the systemic venous system. They are commonly found at the lower end of the oesophagus and gastric fundus. Caput medusae (i.e., the Head of Medusa, the Greek Gorgon who had snakes on her head instead of hair) is a rare site which appears around the umbilicus if the umbilical vein (portal) remains patent in adulthood and communicates with the superior and inferior epigastric veins (systemic) [Figure 1].[1] It is unsightly and may sometimes rupture with fatal consequences.[2]
Figure 1: Anatomical basis of caput medusae

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A 23-year-old male presented with complaints of enlarged abdominal wall veins [Figure 2].
Figure 2: The caput medusae

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On imaging, he had an enlarged spleen and multiple intra-abdominal collaterals and was diagnosed to have non-cirrhotic portal fibrosis after confirmation with a liver biopsy. He also had hypersplenism.

His chief complaints were vague left upper quadrant pain and the unsightly appearance of his abdomen. He was offered splenectomy and gastro-oesophageal devascularisation. At the midline incision, we encountered large subcutaneous veins under high pressure [Figure 3] and a distended and tortuous patent umbilical vein at the lower edge of the falciform ligament [Figure 4]. We removed the large spleen [Figure 5], ligated the umbilical vein and devascularised the upper stomach and lower oesophagus. After operation, the Caput medusae disappeared [Figure 6].
Figure 3: Distended subcutaneous venous collaterals

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Figure 4: Large umbilical vein

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Figure 5: Massive spleen (1600 g) with dilated splenic vein

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Figure 6: After operation

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Akhter NM, Haskal ZJ. Diagnosis and management of ectopic varices. Gastrointest Interv 2012;1:3-10.  Back to cited text no. 1
Melas N, Haji Younes A, Magnusson P. A case of fatal cutaneous caput medusae hemorrhage. Clin Case Rep 2019;7:452-5.  Back to cited text no. 2


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]


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