A case report of portal hypertension and upper gastrointestinal hemorrhage caused by portal tuberculosis

Abdominal tuberculosis (TB) is a rare type of extra-pulmonary TB that can occur in any organ or tissue of the abdominal cavity. The order of frequency of occurrence reported previously in the literature is as follows: gastrointestinal tract, retroperitoneal tissue, mesenteric lymph nodes, and abdominal organs (< 1%). Cases of invasion to the portal vein, liver, and pancreas and concurrent pancreatic portal hypertension are extremely rare. So far, only 6 related cases have been reported at home and abroad. However, there has been no report of simple abdominal TB causing portal vein stenosis and subsequent gastrointestinal hemorrhage. Our center reported the case of a 30-year-old female with a 3-year history of pulmonary TB, recent hematemesis, melena, anorexia, and pancytopenia. Computed tomography (CT) showed a left hepatic mass, portal vein stenosis, esophageal varices, and splenomegaly. After CT-guided biopsy failed to identify the cause, surgical intervention determined that the portal vein stenosis in this patient was due to caseous necrosis that had invaded the portal vein trunk. These findings suggest that when patients present with portal hypertension and esophageal varices of unknown cause, abdominal TB should be included in the differential diagnosis. This study also describes the effect of lymph node TB on the duodenal ligament of the liver.