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Cavernous transformation of the portal vein (CTPV) is a rare condition characterized by the formation of multiple tortuous tiny blood vessels within and around a portal vein which has been occluded by thrombus. Early diagnosis of CTPV is relevant for timely intervention which could save the liver from non-reversible damage

Introduction: Cavernous transformation of the portal vein, although a hepatic condition, may manifest with clinical features similar to those in patients with gastrointestinal pathologies. Particularly in young patients with no prior history of alcoholism or hepatic pathology, the diagnosis of cavernous transformation of the portal vein may be missed in an emergency setting where patients’ reported symptoms may be mimicking those associated with bleeding peptic ulcer or other gastrointestinal pathologies. Case Report: We present a case of a 22-year-old male with no prior history of hepatic or pancreatic pathology who presented to the emergency room with some episodes of haematemesis, melena and slight dizziness, in whom a cavernous transformation of the portal vein was identified by abdominal duplex ultrasonography. Discussion: The clinical diagnosis of cavernous transformation of the portal vein can be challenging and easily missed especially in instances where a patient with no history of chronic alcoholism, liver cirrhosis, hepatoma, pancreatitis or prior abdominal surgery presents to the emergency room with haematemesis and anaemia. Ultrasonography presents as a reliable radiological tool in the diagnosis of rare and unforeseen conditions like cavernous transformation of the portal vein to allow for prompt management and prevention of adverse patients’ outcomes. Conclusion: Abdominal duplex ultrasonography can reliably aid in the prompt diagnosis and management of patients with unforeseen rare hepatic pathologies such as cavernous transformation of the portal vein who present with upper gastrointestinal bleeding.