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Identification and Management of Abdominal Wall Varices in Pregnancy

Wood, Amber M., MD; Grotegut, Chad A., MD, MHS; Ronald, James, MD, PhD; Pabon-Ramos, Waleska, MD; Pedro, Christina, MD; Knechtle, Stuart J., MD; Wysokinska, Ewa, MD; Rubin, Geoffrey D., MD; Brady, Carla W., MD, MHS; Gilner, Jennifer B., MD, PhD

doi: 10.1097/AOG.0000000000002805
Case Report: PDF Only

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.

Abdominal wall varices were identified on obstetric ultrasonography in a patient with liver cirrhosis and portal hypertension, allowing for variceal treatment before delivery.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, the Department of Radiology, Division of Interventional Radiology, the Department of Anesthesia, Division of Women's Anesthesia, the Department of General Surgery, Division of Abdominal Transplant Surgery, the Department of Medicine, Division of Hematology and Oncology, the Department of Radiology, Division of Cardiothoracic Imaging, and the Department of Medicine, Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina.

Corresponding author: Jennifer B. Gilner, MD, PhD, Department of Obstetrics and Gynecology, DUMC 3967, Durham, NC 27705; email: jennifer.gilner@duke.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received April 25, 2018

Received in revised form June 05, 2018

Accepted June 14, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.