Case 30-1989

Presentation of CaseA 52-year-old man was admitted to the hospital because of esophageal varices and repeated bouts of upper gastrointestinal bleeding.There was a 10-year history of vague pain in the right upper abdominal quadrant. Six years before entry the patient experienced the first bout of upper gastrointestinal bleeding. Four years before admission an upper gastrointestinal series, performed elsewhere, was reported to show extensive esophageal and gastric varices, without ulceration. Two years later massive hematemesis recurred and required the transfusion of 19 units of blood.Fifteen months before admission evaluation elsewhere showed that the spleen descended 6 cm below . . .