Splanchnic arteriovenous communication presenting with portal vein aneurysm and portal hypertensive bleeding

Portal hypertension usually results from chronic liver disease; however, non-cirrhotic portal hypertension caused by vascular abnormalities, such as portal vein aneurysm and splanchnic arteriovenous communication, is extremely rare and may present with life-threatening gastrointestinal bleeding.We describe a 20-year-old man who presented with acute upper gastrointestinal bleeding and ascites.Evaluation revealed a superior mesenteric artery pseudoaneurysm communicating with the superior mesenteric vein near the splenoportal confluence, resulting in aneurysmal dilatation of the portal vein and portal hypertension.This case highlights that splanchnic arteriovenous communication can result in portal vein aneurysm and cause severe non-cirrhotic portal hypertensive bleeding.Accurate diagnosis requires a high index of suspicion and advanced angiographic imaging, and management should be multidisciplinary, including endoscopy, interventional radiology, anticoagulation, and, when necessary, surgical repair.