A 30-year-old woman presented with a 3-year history of recurrent melena, without haematemesis, abdominal pain or fever. The lowest hemoglobin was 30 g/L. She had a history of congenital choledochal cyst and underwent extrahepatic bile duct resection with Roux-en-Y cholangiojejunostomy 26 years ago. Eight years before, she got abdominal cavity infection following by pancreatic pseudocyst. Gastroscopy and colonoscopy showed no bleeding lesions. Computed tomography scan revealed portal vein cavernous transformation (Figure 1A, red arrow) at bilioenteric anastomosis (Figure 1A, yellow arrow). Roux-en-Y loop varices (Figure 1B, white arrow) bleeding due to portal hypertension caused by portal vein cavernous transformation (Figure 1B, red arrow) was suspected. She received treatment for this obscure gastrointestinal bleeding but eventually died of massive hemorrhage.
Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/hbsn.2020.02.07). The authors have no conflicts of interest to declare.
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