Plug-assisted retrograde transvenous obliteration for the treatment of gastric variceal bleeding in absence of gastrorenal or gastrocaval shunt: A case report

Plug-assisted retrograde tansvenous obliteration (PARTO) is commonly used to treat gastric variceal bleeding. PARTO is typically performed via the gastrorenal shunt or gastrocaval shunt and there have been no reports of PARTO performed through the pericardial vein in cases of gastric varices in which there is no gastrorenal or gastrocaval shunt. Herein, we report a case of PARTO was performed to treat gastric variceal bleeding in a patient with a gastric varix without a gastrorenal or gastrocaval shunt. PATIENT CONCERNS: A 54-year-old man with alcoholic liver cirrhosis presented to the emergency room with hematemesis and melena. At presentation, the patient’s blood pressure was 130/70 mm Hg and hemoglobin level was 10.1 g/dL. DIAGNOSES: Computed tomography (CT) scan and endoscopic examination revealed a gastric varix at the gastric fundus. INTERVENTIONS: PARTO was performed to treatment of gastric variceal bleeding via the pericardial vein. OUTCOMES: The patient did not show any signs of variceal bleeding after the procedure, and follow-up CT at 3 weeks showed complete resolution of the gastric varix. LESSONS: Although PARTO is technically difficult to perform through pathways other than the gastrorenal or gastrocaval shunt, it can be a beneficial alternative in cases in which other treatments fail or are not feasible.