Ectopic varices leading to occult haemorrhage in portal hypertension: a surgical quandary.

When portal venous pressure exceeds 12 mmHg, portosystemic collaterals develop. Common sites include the oesophago-gastric junction, bare area of the liver, anterior abdominal wall, and the anorectal junction. Variceal haemorrhage from the oesophago-gastric junction is voluminous, overt, and usually easily accessible, however occult bleeding from ectopic varices presents the ultimate challenge to those managing gastrointestinal haemorrhage. In this article we describe two cases of ectopic varices with an outline of the management strategy for such patients.