DOI: https://doi.org/10.36347/sjmcr.2026.v14i11.009

Pages: 2441-2443

Segmental [left-sided] portal hypertension is a rare condition resulting from isolated splenic vein obstruction, most commonly secondary to pancreatic disease. Splenic hydatid cyst as an underlying cause is exceptional, with only a few cases reported. We report the case of a 75-year-old patient with a history of type 2 diabetes, hypertension, coronary artery bypass grafting on antiplatelet therapy, and prior surgery for a splenic hydatid cyst in 2016, who presented with recurrent upper gastrointestinal bleeding. The patient experienced three episodes of hematemesis associated with melena, the last occurring 15 days before admission. On examination, the patient was hemodynamically stable with marked asthenia. Upper gastrointestinal endoscopy revealed no esophageal varices, mild portal hypertensive gastropathy, and a large isolated fundal gastric varix, with red signs, successfully treated by cyanoacrylate injection; suggestive of segmental portal hypertension. Laboratory findings showed mild anemia [hemoglobin 11.1 g/dL] with preserved liver function. Abdominal ultrasonography demonstrated a 6 × 5.5 cm anechoic lesion at the splenic hilum, suggestive of a recurrent hydatid cyst or postoperative sequela causing splenic vein compression. Hydatid serology was positive. Splenic involvement accounts for only 0.5–4% of hydatid disease localizations, and its association with segmental portal hypertension remains exceedingly rare. This case highlights an unusual cause of segmental portal hypertension revealed by isolated gastric variceal bleeding and underscores the importance of considering hydatid disease in endemic regions.