At the focal point| Volume 94, ISSUE 1, P189-191, July 2021

Portal hypertensive cholepathy

Published:February 09, 2021DOI:
      A 57-year-old man with nonalcoholic steatohepatitis, newly diagnosed hepatocellular carcinoma, and portal hypertension with acalculous cholecystitis had previously undergone endoscopic cholecystostomy because he was deemed to be an inoperable candidate for cholecystectomy. He presented 8 weeks later for removal of the lumen-apposing metal stent (LAMS) because his symptoms had improved. Endoscopic inspection of the gallbladder mucosa revealed a mosaic pattern suggestive of portal hypertensive changes of the gallbladder mucosa. The mucosa appeared erythematous and edematous (A) with a mosaic-like pattern (B) and a scarlatina-like appearance (C) when viewed up close. Although subtle upon initial viewing, when compared with images of the gallbladder mucosa of a patient without features of portal hypertension (D), the variance in mucosal appearance was conspicuous. Portal hypertensive gastropathy (PHG) is a well-known phenomenon; however, portal hypertensive cholepathy (also known as portal hypertension−related change in gallbladder mucosa) as an entity is not well known. The findings in our patient could be likened to findings of mild PHG, where the gastric mucosa appears reddened and edematous with a snakeskin pattern. We believe this is the first reported case of portal hypertensive cholepathy.
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