We present a case of massive bleeding secondary to vaginal varices complicating portal hypertension in a patient awaiting orthotopic liver transplantation (OLT). The vagina is among the rarest of locations reported for portal hypertensive varices causing hemorrhage; in fact, our patient represents only the seventh such case since the first report by Kreek in 1967 1-5 and the only case in which the initial and definitive management was OLT.
A 58-year-old white female, gravida 3, para 3, was referred to our transplant center for liver transplant evaluation for nonalcoholic steatohepatitis. Her past medical history included diabetes mellitus type 2 and nephrolithiasis, and her surgical history was notable for a total abdominal hysterectomy performed 17 years earlier for endometriosis as well as open cholecystectomy, bilateral tubal ligation, and renal lithotripsy. On physical examination, she had mild ascites but was otherwise unremarkable. Upon completion of the transplant evaluation, she was activated on the transplant waiting list.
Approximately 1 year after she was listed, the patient underwent routine computed tomography imaging, which showed a small, cirrhotic liver without ascites, and patent vasculature. Three months later, she presented with a sudden onset of significant vaginal bleeding. Vaginal varices were identified by direct visualiza-