A 41-year-old woman with a history of obesity and spontaneous abortion was admitted to the ICU due to rectal bleeding and anemia that did not improve after transfusion. Colonoscopy and gastroscopy were performed, during which no bleeding point was detected, although some remains of fresh blood were observed. Computed tomography showed abundant varices in the proximal jejunum (Fig. 1) compatible with portal hypertension secondary to chronic thrombosis of the superior mesenteric vein (Fig. 2).
Urgent laparotomy was performed, which revealed dilated tortuous veins in the first 60 cm of the small intestine. This was resected up to the third part of the duodenum, and a vacuum-assisted closure device was used for a subsequent second-look surgery. In the second procedure 72 h later, a duodenal-jejunal anastomosis was performed.
