Gastric Variceal Bleed in Pregnancy

Abstract

Gastric variceal bleeding is a rare but life-threatening complication of portal hypertension, posing significant management challenges during pregnancy. We report the case of a 25-year-old primigravida at 18 weeks of gestation who presented with hematemesis and melena. On examination, she was pale and tachycardic, with splenomegaly noted. Laboratory investigations revealed anemia and thrombocytopenia. Doppler ultrasound confirmed the presence of a portal cavernoma and splenomegaly. Upper gastrointestinal endoscopy showed large esophageal varices (EV) and fundal gastric varices (GOV2) with stigmata of recent bleeding, along with portal hypertensive gastropathy. Endoscopic management was carried out in two sessions. In the first session, cyanoacrylate glue injection achieved immediate hemostasis of the actively bleeding gastric varices. Forty-eight hours later, endoscopic variceal ligation was performed for the EV, resulting in complete obliteration. The patient remained stable postprocedure, with uneventful monitoring. Close multidisciplinary follow-up ensured favorable maternal and fetal outcomes. The pregnancy progressed without further complications, and at 39 weeks of gestation, the patient delivered a healthy baby via elective cesarean section. This case highlights the importance of early diagnosis, timely endoscopic intervention, and a coordinated multidisciplinary approach in the successful management of variceal bleeding during pregnancy.