Portal hypertension usually manifests with gastroesophageal varices, portal hypertensive gastropathy, ascites, and hepatic encephalopathy. Although stomal varices have been described in colostomies, ileostomies, and urostomies, bleeding portal hypertensive enteropathy (PHE) involving an ileal conduit urostomy is previously unreported. A 58-year-old man with bladder and prostate cancer status post-cystoprostatectomy with ileal conduit urostomy, obesity, chronic kidney disease, and metabolic dysfunction and alcohol-associated liver disease-related cirrhosis presented with multiple admissions for recurrent gross hematuria via urostomy secondary to stomal bleeding and anemia. He required multiple hospitalizations for blood transfusions. CT imaging demonstrated cirrhosis and peristomal varices, while portal venography confirmed a 12 mm Hg portal-systemic gradient. Endoscopy of the conduit showed mucosal congestion consistent with PHE. Multiple interventions, including embolosclerotherapy, transhepatic variceal embolization, and carvedilol, provided only temporary relief. A transjugular intrahepatic portosystemic shunt was performed and he did not experience any further stomal bleeding. This case highlights a unique presentation of PHE manifesting as recurrent large-volume urostomy bleeding, expanding the clinical spectrum of ectopic varices and PHE-related hemorrhage. Recognition of this entity is essential for timely diagnosis and multidisciplinary management.

Portal vein stenosis (PVS) is a rare but potentially devastating complication arising after definitive treatment of pancreatic cancer. The condition can manifest as symptomatic ascites, abdominal pain, splenomegaly, thrombocytopenia, as well as hemorrhage secondary to gastric or esophageal varices. The etiology is often multifactorial but has been associated with tumor progression, chemotherapy, vascular surgery, and radiation. We present a case in which a man with borderline-resectable pancreatic cancer developed symptomatic ascites secondary to PVS following treatment with neoadjuvant chemotherapy and subsequent 5-fraction MRI-guided adaptive radiation therapy and pancreaticoduodenectomy with vascular reconstruction. Though the incidence of PVS after ablative radiation therapy and surgery for pancreatic cancer appears to be low, it may be under-reported, and patients should be closely monitored in the setting of re-irradiation or planned vascular reconstruction. These findings may help inform future radiation therapy treatment planning guidelines to avoid excessive dose to the portal vein.

A spontaneous adrenal hemorrhage is a rare complication occurring in the setting of interventional radiology procedures. Here, we present the case of a 73-year-old male who underwent CT-guided drainage of a periduodenal collection. During the procedure, he developed sudden onset left back pain and hypertension, which revealed a left adrenal gland hemorrhage on CT imaging. Potential mechanisms for this complication include a physiological stress response, procedure-associated hypercoagulability, and direct trauma to the adrenal gland. Moreover, an adrenal hemorrhage should be monitored closely as it can lead to severe clinical consequences requiring treatment with IV analgesics and antihypertensives.